Parent Vessel and Intrasacular Devices for Occluding a Cerebral Aneurysm

ABSTRACT

An intrasacular aneurysm occlusion device can be a peanut, hourglass, and/or hyperbolic shaped mesh which is inserted and expanded within an aneurysm sac. The proximal lobe of the device reduces blood flow into the sac through the aneurysm neck and the distal lobe of the device contacts the dome of the sac so as to keep the proximal lobe from shifting. The narrow center portion of the peanut, hourglass, or hyperbolic mesh can bend so that the device at least partially conforms to the interior of an irregularly-shaped aneurysm sac.

CROSS-REFERENCE TO RELATED APPLICATIONS

This present application claims the priority benefit of provisionalpatent application 63/119,774 filed on 2020 Dec. 1. This presentapplication is also a continuation-in-part of patent application Ser.No. 16/693,267 filed on 2019 Nov. 23. This present application is also acontinuation-in-part of patent application Ser. No. 16/660,929 filed on2019 Oct. 23. This present application is also a continuation-in-part ofpatent application Ser. No. 16/541,241 filed on 2019 Aug. 15.

Application Ser. No. 16/693,267 is a continuation-in-part of patentapplication Ser. No. 16/660,929 filed on 2019 Oct. 23. Application Ser.No. 16/693,267 claimed the priority benefit of provisional patentapplication 62/794,609 filed on 2019 Jan. 19. Application Ser. No.16/693,267 claimed the priority benefit of provisional patentapplication 62/794,607 filed on 2019 Jan. 19. Application Ser. No.16/693,267 was a continuation-in-part of patent application Ser. No.16/541,241 filed on 2019 Aug. 15. Application Ser. No. 16/693,267 was acontinuation-in-part of patent application Ser. No. 15/865,822 filed on2018 Jan. 9 and issued as patent Ser. No. 10/716,573 on 2020 Jul. 21.Application Ser. No. 16/693,267 was a continuation-in-part of patentapplication Ser. No. 15/861,482 filed on 2018 Jan. 3.

Application Ser. No. 16/660,929 claimed the priority benefit ofprovisional patent application 62/794,609 filed on 2019 Jan. 19.Application Ser. No. 16/660,929 claimed the priority benefit ofprovisional patent application 62/794,607 filed on 2019 Jan. 19.Application Ser. No. 16/660,929 was a continuation-in-part of patentapplication Ser. No. 16/541,241 filed on 2019 Aug. 15. Application Ser.No. 16/660,929 was a continuation-in-part of patent application Ser. No.15/865,822 filed on 2018 Jan. 9 and issued as patent Ser. No. 10/716,573on 2020 Jul. 21. Application Ser. No. 16/660,929 was acontinuation-in-part of patent application Ser. No. 15/861,482 filed on2018 Jan. 3.

Application Ser. No. 16/541,241 claimed the priority benefit ofprovisional patent application 62/794,609 filed on 2019 Jan. 19.Application Ser. No. 16/541,241 claimed the priority benefit ofprovisional patent application 62/794,607 filed on 2019 Jan. 19.Application Ser. No. 16/541,241 claimed the priority benefit ofprovisional patent application 62/720,173 filed on 2018 Aug. 21.Application Ser. No. 16/541,241 was a continuation-in-part of patentapplication Ser. No. 15/865,822 filed on 2018 Jan. 9 and issued aspatent Ser. No. 10/716,573 on 2020 Jul. 21.

Application Ser. No. 15/865,822 claimed the priority benefit ofprovisional patent application 62/589,754 filed on 2017 Nov. 22.Application Ser. No. 15/865,822 claimed the priority benefit ofprovisional patent application 62/472,519 filed on 2017 Mar. 16.Application Ser. No. 15/865,822 was a continuation-in-part of patentapplication Ser. No. 15/081,909 filed on 2016 Mar. 27. Application Ser.No. 15/865,822 was a continuation-in-part of patent application Ser. No.14/526,600 filed on 2014 Oct. 29.

Application Ser. No. 15/861,482 claimed the priority benefit ofprovisional patent application 62/589,754 filed on 2017 Nov. 22.Application Ser. No. 15/861,482 claimed the priority benefit ofprovisional patent application 62/472,519 filed on 2017 Mar. 16.Application Ser. No. 15/861,482 claimed the priority benefit ofprovisional patent application 62/444,860 filed on 2017 Jan. 11.Application Ser. No. 15/861,482 was a continuation-in-part of patentapplication Ser. No. 15/080,915 filed on 2016 Mar. 25 and issued aspatent Ser. No. 10/028,747 on 2018 Jul. 24. Application Ser. No.15/861,482 was a continuation-in-part of patent application Ser. No.14/526,600 filed on 2014 Oct. 29.

Application Ser. No. 15/081,909 was a continuation-in-part of patentapplication Ser. No. 14/526,600 filed on 2014 Oct. 29. Application Ser.No. 15/080,915 was a continuation-in-part of patent application Ser. No.14/526,600 filed on 2014 Oct. 29. Application Ser. No. 14/526,600claimed the priority benefit of provisional patent application61/897,245 filed on 2013 Oct. 30. Application Ser. No. 14/526,600 was acontinuation-in-part of patent application Ser. No. 12/989,048 filed on2010 Oct. 21 and issued as U.S. Pat. No. 8,974,487 on 2015 Mar. 10.Application Ser. No. 12/989,048 claimed the priority benefit ofprovisional patent application 61/126,047 filed on 2008 May 1.Application Ser. No. 12/989,048 claimed the priority benefit ofprovisional patent application 61/126,027 filed on 2008 May 1.

The entire contents of these related applications are incorporatedherein by reference.

FEDERALLY SPONSORED RESEARCH

Not Applicable

SEQUENCE LISTING OR PROGRAM

Not Applicable

BACKGROUND—FIELD OF INVENTION

This invention relates to devices for occluding cerebral aneurysms.

INTRODUCTION

An aneurysm is an abnormal bulging of a blood vessel wall. The vesselfrom which the aneurysm protrudes is the parent vessel. Saccularaneurysms look like a sac protruding out from the parent vessel.Saccular aneurysms have a neck and can be prone to rupture. Fusiformaneurysms are a form of aneurysm in which a blood vessel is expandedcircumferentially in all directions. Fusiform aneurysms generally do nothave a neck and are less prone to rupturing than saccular aneurysms. Asan aneurysm grows larger, its walls generally become thinner and weaker.This decrease in wall integrity, particularly for saccular aneurysms,increases the risk of the aneurysm rupturing and hemorrhaging blood intothe surrounding tissue, with serious and potentially fatal healthoutcomes.

Cerebral aneurysms, also called brain aneurysms or intracranialaneurysms, are aneurysms that occur in the intercerebral arteries thatsupply blood to the brain. The majority of cerebral aneurysms form atthe Junction of arteries at the base of the brain that is known as theCircle of Willis where arteries come together and from which thesearteries send branches to different areas of the brain. Althoughidentification of intact aneurysms is increasing due to increased use ofoutpatient imaging such as outpatient MRI scanning, many cerebralaneurysms still remain undetected unless they rupture. If they dorupture, they often cause stroke, disability, and/or death. Theprevalence of cerebral aneurysms is generally estimated to be in therange of 1%-5% of the general population or approximately 3-15 millionpeople in the U.S. alone. Approximately 30,000 people per year suffer aruptured cerebral aneurysm in the U.S. alone. Approximately one-third toone-half of people who suffer a ruptured cerebral aneurysm die withinone month of the rupture. Sadly, even among those who survive,approximately one-half suffer significant and permanent deterioration ofbrain function. Better alternatives for cerebral aneurysm treatment areneeded.

REVIEW OF THE RELEVANT ART

U.S. patent application 20150196744 (Aboytes, Jul. 16, 2015, “Devicesand Method for Vascular Recanalization”) and U.S. Pat. No. 9,931,495(Aboytes, Apr. 3, 2018, “Devices and Methods for VascularRecanalization”) disclose a device for restoring blood flow through anobstructed blood vessel. U.S. Pat. No. 8,974,512 (Aboytes et al., Mar.10, 2015, “Devices and Methods for the Treatment of Vascular Defects”),U.S. Pat. No. 8,998,947 (Aboytes et al., Apr. 7, 2015, “Devices andMethods for the Treatment of Vascular Defects”), and U.S. Pat. No.9,844,382 (Aboytes et al., Dec. 19, 2017, “Devices and Methods for theTreatment of Vascular Defects”), and U.S. patent applications20120239074 (Aboytes et al., Sep. 20, 2012, “Devices and Methods for theTreatment of Vascular Defects”), 20130116722 (Aboytes et al., May 9,2013, “Devices and Methods for the Treatment of Vascular Defects”),20150209050 (Aboytes et al., Jul. 30, 2015, “Devices and Methods for theTreatment of Vascular Defects”), 20150272590 (Aboytes et al., Oct. 1,2015, “Devices and Methods for the Treatment of Vascular Defects”),20150342613 (Aboytes et al., Dec. 3, 2015, “Devices and Methods for theTreatment of Vascular Defects”), 20160262766 (Aboytes et al., Sep. 15,2016, “Devices and Methods for the Treatment of Vascular Defects”),20180125501 (Aboytes et al., May 10, 2018, “Devices and Methods for theTreatment of Vascular Defects”), 20180132859 (Aboytes et al., May 17,2018, “Devices and Methods for the Treatment of Vascular Defects”),20180132862 (Aboytes et al., May 17, 2018, “Devices and Methods for theTreatment of Vascular Defects”), 20190105054 (Aboytes et al., Apr. 11,2019, “Devices and Methods for the Treatment of Vascular Defects”),20190105056 (Aboytes et al., Apr. 11, 2019, “Devices and Methods for theTreatment of Vascular Defects”), and 20180036012 (Aboytes et al., Feb.8, 2018, “Devices, Systems, and Methods for the Treatment of VascularDefects”) disclose intrasaccular ribbons for aneurysm occlusion. U.S.patent Ser. No. 10/617,426 (Aboytes et al., Apr. 14, 2020, “Devices andMethods for the Treatment of Vascular Defects”), Ser. No. 10/617,427(Aboytes et al., Apr. 14, 2020, “Devices and Methods for the Treatmentof Vascular Defects”), and Ser. No. 10/675,037 (Aboytes et al., Jun. 9,2020, “Devices and Methods for the Treatment of Vascular Defects”), aswell as U.S. patent application 20200205841 (Aboytes et al., Jul. 2,2020, “Devices, Systems, and Methods for the Treatment of VascularDefects”), disclose a ribbon-like intrasacular implant with first andsecond portions, wherein the first and second portions have a firstconfiguration in which are linearly aligned and a second configurationin which they overlap.

U.S. patent application 20020026210 (Abdel-Gawwad, Feb. 28, 2002,“Endovascular Aneurysm Treatment Device and Method”) discloses using anintrasacular frame and suction to collapse an aneurysm. U.S. patentapplication 20190307546 (Aguilar et al., Oct. 10, 2019, “Embolic Devicewith Improved Neck Coverage”) discloses a helical intrasaccular device.U.S. patent application 20190223883 (Anderson et al., Jul. 25, 2019,“Occlusive Medical Device with Delivery System”) discloses a neck bridgeto occlude a heart appendage. U.S. patent application 20190251866(Babiker et al., Aug. 15, 2019, “Device Specific Finite Element Modelsfor Simulating Endovascular Treatment”) discloses using finite elementmedical device models and computational fluid dynamics for aneurysmtreatment. U.S. patent Ser. No. 10/426,487 (Bachman et al., Oct. 1,2019, “Devices, Systems and Methods for Enclosing an AnatomicalOpening”) discloses a device with a distal-facing portion which occludesan aneurysm and a proximal-facing portion which arches over lumina of anartery.

U.S. Pat. No. 9,980,733 (Badruddin et al., May 29, 2018, “System for andMethod of Treating Aneurysms”) and Ser. No. 10/856,879 (Badruddin etal., Dec. 8, 2020, “System for and Method of Treating Aneurysms”)disclose an occlusion device with a cover and an inner anchoring member,wherein the cover expands to a diameter greater than an aneurysm neckand the inner anchoring member contacts the interior of the aneurysm.U.S. patent application 20200367895 (Badruddin et al., Nov. 26, 2020,“Systems and Methods for Treating Aneurysms”) and patent Ser. No.10/856,880 (Badruddin et al., Dec. 8, 2020, “Systems and Methods forTreating Aneurysms”) disclose an implantable device with a proximal endseated against an aneurysm adjacent the neck and a distal end extendingin the sac away from the neck.

U.S. patent application 20020026217 (Baker et al., Feb. 28, 2002,“Apparatus and Method for Repair of Perigraft Flow”) discloses a devicefor causing thrombus between a graft and an aneurysm wall. U.S. patentapplications 20170079661 (Bardsley et al., Mar. 23, 2017, “OcclusiveDevices”) and 20190269411 (Bardsley et al., Sep. 5, 2019, “OcclusiveDevices”) disclose dual-layer inverted meshes for vascular occlusion.U.S. patent Ser. No. 10/314,593 (Bardsley et al., Jun. 11, 2019,“Occlusive Devices”) discloses dual-layer inverted meshes for vascularocclusion. U.S. patent application 20060052816 (Bates et al., Mar. 9,2006, “Device for Treating an Aneurysm”) discloses a patch that coversan aneurysm neck. U.S. Pat. No. 9,393,022 (Becking et al., Jul. 19,2016, “Two-Stage Deployment Aneurysm Embolization Devices”) disclosesembolic implants which are deployed in two stages. U.S. patentapplication 20170252190 (Becking et al., Sep. 7, 2017, “Braid ImplantDelivery Systems”) discloses neurovascular devices with low profilecompressibility. U.S. patent application 20200367904 (Becking et al.,Nov. 26, 2020, “Multiple Layer Filamentary Devices for Treatment ofVascular Defects”) discloses braided balls which reduce blood flow intoan aneurysm. U.S. patent application 20190262002 (Benjamin, Aug. 29,2019, “Novel Enhanced Orb-Like Intrasacular Device”) discloses anorb-shaped device with zones of flexure and open cells.

U.S. Pat. No. 5,690,666 (Berenstein et al., Nov. 25, 1997, “UltrasoftEmbolism Coils and Process for Using Them”) discloses ultrasoft embolismcoils. U.S. Pat. No. 7,695,488 (Berenstein et al., Apr. 13, 2010,“Expandable Body Cavity Liner Device”) discloses an aneurysm liner withareas with different elasticities. U.S. patent application 20040010263(Boucher et al., Jan. 15, 2004, “Expandable Preformed Structures forDeployment in Interior Body Regions”) discloses using a stylet tostraighten an expandable structure during deployment into an interiorbody region. U.S. patent Ser. No. 10/406,010 (Bourang, Sep. 10, 2019,“Multi-Stent and Multi-Balloon Apparatus for Treating Bifurcations andMethods of Use”) discloses using two catheters and three stents to treata bifurcated vessel. U.S. patent application 20190046210 (Bowman, Feb.14, 2019, “Embolic Device with Shaped Wire”) discloses using a helicalcarrier to occlude an aneurysm.

U.S. patent application 20190069900 (Cam et al., Mar. 7, 2019, “VascularRemodeling Device”) discloses a vascular remodeling device with a firstsection and a protruding section. U.S. patent application 20210000624(Cam et al., Jan. 7, 2021, “Vascular Remodeling Device”) discloses avascular remodeling device with a proximal section, an intermediatesection, and a distal section, wherein the distal section is positionedin a vessel bifurcation. U.S. patent application 20190167270 (Chen, Jun.6, 2019, “Vaso-Occlusive Devices with In-Situ Stiffening”) discloses avaso-occlusive device that is constructed out of dissimilar metallicmaterials which cause galvanic corrosion. U.S. patent application20200170647 (Chen et al., Jun. 4, 2020, “Vaso-Occlusive Device”)discloses a gold-platinum alloy vaso-occlusive structure which isimplanted in an aneurysm sac. U.S. patent application 20190133795(Choubey, May 9, 2019, “Meshes, Devices and Methods for TreatingVascular Defects”) discloses stents with a plurality of strut regionsand a plurality of bridge regions. U.S. patent application 20190192322(Choubey et al., Jun. 27, 2019, “Vascular Flow Diversion”) discloses adevice with a plurality of connector sections extendingcircumferentially about the device. U.S. patent applications 20190269534(Choubey, Sep. 5, 2019, “Thin Film Mesh Hybrid for Treating VascularDefects”) and 20170273692 (Choubey, Sep. 28, 2017, “Thin WallConstructions for Vascular Flow Diversion”) disclose stents with strutregions extending circumferentially about the expandable device.

U.S. patent application 20120283768 (Cox et al., Nov. 8, 2012, “Methodand Apparatus for the Treatment of Large and Giant Vascular Defects”)discloses a plurality of self-expanding globular shells which areinserted into an aneurysm sac. U.S. patent application 20170245862 (Coxet al., Aug. 31, 2017, “Methods and Devices for Treatment of VascularDefects”) discloses a method for inserting a self-expanding globularshell into an aneurysm sac. U.S. patent application 20140052233 (Cox etal., Feb. 20, 2014, “Methods and Devices for Treatment of VascularDefects”) discloses a self-expanding globular shell which is insertedinto an aneurysm sac. U.S. Pat. No. 6,511,468 (Cragg et al., Jan. 28,2003, “Device and Method for Controlling Injection of Liquid EmbolicComposition”) discloses a system to deliver liquid embolic material intoan aneurysm. U.S. patent application 20190150932 (Cruise et al., May 23,2019, “Embolization Device Constructed from Expansile Polymer”)discloses expandable polymer devices for aneurysm occlusion. U.S. patentapplication 20190240050 (Dawson et al., Aug. 8, 2019, “VascularExpandable Devices”) discloses a tubular structure made with a pluralityof braided metallic elements. U.S. patent applications 20190239895(Dawson et al., Aug. 8, 2019, “Vascular Expandable Devices”) and2019024004 9 (Dawson et al., Aug. 8, 2019, “Vascular ExpandableDevices”) disclose a device with a generally tubular sidewall formed bybraided strands.

U.S. patent application 20200289125 (Dholakia et al., Sep. 17, 2020,“Filamentary Devices Having a Flexible Joint for Treatment of VascularDefects”) discloses a permeable implant with first and second permeableshells, wherein the first permeable shell has a proximal end with aconcave or recessed section and the second permeable shell has a convexsection that mates with the concave or recessed section. U.S. patentapplication 20170281194 (Divino et al., Oct. 5, 2017, “Embolic MedicalDevices”) discloses intrasaccular ribbons for aneurysm occlusion. U.S.patent Ser. No. 10/433,853 (Divino et al., Oct. 8, 2019, “EmbolicMedical Devices”) discloses an intrasaccular ribbon for aneurysmocclusion with a pre-insertion rolled configuration. U.S. patent Ser.No. 10/327,781 (Divino et al., Jun. 25, 2019, “Occlusive Devices”) andU.S. patent application 20140135812 (Divino et al., May 15, 2014,“Occlusive Devices”) disclose intrasaccular occlusion which are filledwith liquid embolic material and expand to a pre-set shape. U.S. patentapplications 20190282242 (Divino et al., Sep. 19, 2019, “OcclusiveDevices”) and 2019029028 6 (Divino et al., Sep. 26, 2019, “OcclusiveDevices”) disclose intrasaccular occlusion devices which are filled withliquid embolic material and expand to a pre-set shape. U.S. patentapplication 20190343532 (Divino et al., Nov. 14, 2019, “OcclusiveDevices”) discloses an intrasaccular device which changes from acompressed configuration to an expanded configuration with a uniqueshape or porosity profile.

U.S. patent Ser. No. 10/342,548 (Duncan, Jul. 9, 2019, “OcclusionDevices and Methods of Their Manufacture and Use”) discloses a devicewith a lateral fringe on membranous material. U.S. patent application20190362496 (Dutta et al., Nov. 28, 2019, “Isolation of Aneurysm andParent Vessel in Volumetric Image Data”) discloses a framework forisolating an aneurysm and a parent vessel in volumetric image data. U.S.patent application 20150216684 (Enzmann et al., Aug. 6, 2015, “DualRotational Stent Apparatus and Method for Endovascular Treatment ofAneurysms”) discloses a coaxial stent system for aneurysm treatment.U.S. patent application 20190307460 (Ferrera et al., Oct. 10, 2019,“Intrasacular Occlusion Devices Methods Processes and Systems”)discloses flexible aneurysm embolization devices made from laser cutnitinol. U.S. patent application 20200155333 (Franano et al., May 21,2020, “Ballstent Device and Methods of Use”) discloses a round,thin-walled, expandable metal structure made from gold, platinum, orsilver. U.S. patent application 20200163784 (Franano et al., May 28,2020, “Blockstent Device and Methods of Use”) discloses a compressed,cylindrical or oblong, thin-walled, expandable stent for occluding ablood vessel segment.

U.S. patent application 20190223880 (Gerberding et al., Jul. 25, 2019,“Systems and Methods for Supporting or Occluding a Physiological Openingor Cavity”) discloses a device with a distal-facing portion whichoccludes an aneurysm and a proximal-facing portion which arches overlumina of an artery. U.S. Pat. No. 5,334,210 (Gianturco, Aug. 2, 1994,“Vascular Occlusion Assembly”) discloses an occlusion bag with anexpanded diamond shape and an elongated flexible filler member. U.S.patent Ser. No. 10/939,915 (Gorochow et al., Mar. 9, 2021, “AneurysmDevice and Delivery System”) discloses a braid for treating an aneurysm,wherein the braid has a distal end opposite a proximal end, and whereintranslating the braid causes a delivery portion to expand and form adistal sack as well as invert into itself. U.S. patent Ser. No.10/653,425 (Gorochow et al., May 19, 2020, “Layered Braided AneurysmTreatment Device”) discloses a tubular braid that is implanted in twodistinct implanted shapes and a compaction-resistant column spanning theheight of an aneurysm. U.S. patent Ser. No. 10/905,431 (Gorochow, Feb.2, 2021, “Spiral Delivery System for Embolic Braid”) discloses a braidedimplant with a spiral segment.

U.S. patent application 20190216467 (Goyal, Jul. 18, 2019, “Apparatusand Methods for Intravascular Treatment of Aneurysms”) discloses ananeurysm neck bridge deployed in the parent vessel of the aneurysm. U.S.patent application 20180070955 (Greene et al., Mar. 15, 2018, “EmbolicContainment”) discloses systems to deliver liquid embolic material intoan aneurysm. U.S. Pat. No. 6,346,117 (Greenhalgh, Feb. 12, 2002, “Bagfor Use in the Intravascular Treatment of Saccular Aneurysms”) and U.S.Pat. No. 6,391,037 (Greenhalgh, May 21, 2002, “Bag for Use in theIntravascular Treatment of Saccular Aneurysms”) disclose a plurality ofresilient filamentary members braided into a tubular sleeve with anopening to receive a clotting medium such as a platinum wire.

U.S. Pat. No. 9,592,363 (Griffin et al., Mar. 14, 2017, “MedicalDevice”) discloses a device with a shaft having an elongated innermember and an elongated tubular reinforcing member disposed over atleast a portion of the inner member. U.S. patent Ser. No. 10/130,372(Griffin, Nov. 20, 2018, “Occlusion Device”), and U.S. patentapplications 20150313605 (Griffin, Nov. 5, 2015, “Occlusion Device”),20170156734 (Griffin, Jun. 8, 2017, “Occlusion Device”), 20190053810(Griffin, Feb. 21, 2019, “Occlusion Device”), 20190059909 (Griffin, Feb.28, 2019, “Occlusion Device”) disclose an occlusive mesh with acircumferential fold line. U.S. patent application 20190269414 (Griffin,Sep. 5, 2019, “Occlusion Device”) discloses an intrasaccular occlusiondevice with a plurality of coaxial expandable carriages. U.S. patentSer. No. 10/869,672 (Griffin, Dec. 22, 2020, “Occlusion Device”)discloses an occlusion device with a solid marker and a resilient meshbody attached within the marker. U.S. patent application 20200038035(Griffin, Feb. 6, 2020, “Occlusion Device”) discloses an occlusiondevice with a solid marker and a low profile resilient mesh bodyattached to the distal end of the marker. U.S. patent Ser. No.10/285,711 (Griffin, May 14, 2019, “Occlusion Device”) discloses anocclusion device with a continuous compressible mesh structurecomprising axial mesh carriages configured end to end, wherein each endof each carriage is a pinch point in the continuous mesh structure.

U.S. patent Ser. No. 10/426,486 (Guo et al., Oct. 1, 2019,“Vaso-Occlusive Device Delivery System”) discloses a vaso-occlusivedevice delivery system with a heat-activated pusher. U.S. patentapplication 20190262119 (Gupta et al., Aug. 29, 2019, “Delivery Devicefor Use with an Embolic Material”) discloses an embolic materialdelivery assembly with an outer member having a lumen extending therein,a distal end region, and an inner member disposed within the lumen ofthe outer member. U.S. patent applications 20200187953 (Hamel et al.,Jun. 18, 2020, “Devices, Systems, and Methods for the Treatment ofVascular Defects”), 20200187954 (Hamel et al., Jun. 18, 2020, “Devices,Systems, and Methods for the Treatment of Vascular Defects”),20200197017 (Hamel et al., Jun. 25, 2020, “Devices, Systems, and Methodsfor the Treatment of Vascular Defects”), 20200197018 (Hamel et al., Jun.25, 2020, “Devices, Systems, and Methods for the Treatment of VascularDefects”), and 20200197020 (Hamel et al., Jun. 25, 2020, “Devices,Systems, and Methods for the Treatment of Vascular Defects”) disclose amesh which is deployed into a predetermined shape wherein: (a) the meshis curved along its width, (b) the mesh is curved along its length, and(c) the mesh has an undulating contour across at least a portion of oneor both of its length or its width. U.S. patent applications 20190209146(Hebert et al., Jul. 11, 2019, “Micrograft for the Treatment ofIntracranial Aneurysms and Method for Use”), 20190231328 (Hebert et al.,Aug. 1, 2019, “Micrograft for the Treatment of Intracranial Aneurysmsand Method for Use”), and 20190261967 (Hebert et al., Aug. 29, 2019,“Micrograft for the Treatment of Intracranial Aneurysms and Method forUse”) disclose a micrograft with a series of peaks and valleys formed bycrimping.

U.S. patent applications 20180206849 (Hewitt et al., Jul. 26, 2018,“Filamentary Devices for the Treatment of Vascular Defects”) and20170095254 (Hewitt et al., Apr. 6, 2017, “Filamentary Devices forTreatment of Vascular Defects”) disclose a self-expanding globular shellwhich is inserted into an aneurysm sac. U.S. patent application20190223881 (Hewitt et al., Jul. 25, 2019, “Devices for TherapeuticVascular Procedures”) discloses a self-expanding globular shell which isinserted into an aneurysm sac, wherein some shell filaments extendbeyond the distal end of the shell. U.S. Pat. No. 9,955,976 (Hewitt etal., May 1, 2018, “Filamentary Devices for Treatment of VascularDefects”) discloses a self-expanding intrasaccular globular shell withareas with different size pores. U.S. patent application 20160249934(Hewitt et al., Sep. 1, 2016, “Filamentary Devices for Treatment ofVascular Defects”) discloses occlusive meshes with variable meshdensity. U.S. patent application 20160249935 (Hewitt et al., Sep. 1,2016, “Devices for Therapeutic Vascular Procedures”) discloses anexpandable cylindrical structure made of wires with a self-expandingpermeable shell at the distal end of the cylindrical structure. U.S.patent application 20160367260 (Hewitt et al., Dec. 22, 2016, “Devicesfor Therapeutic Vascular Procedures”) discloses an expandablecylindrical structure made of wires and a self-expanding permeable shellat the distal end of the cylindrical structure. U.S. patent application20170128077 (Hewitt et al., May 11, 2017, “Devices for TherapeuticVascular Procedures”) discloses methods and devices for removing athrombus. U.S. Pat. No. 9,492,174 (Hewitt et al., Nov. 15, 2016,“Filamentary Devices for Treatment of Vascular Defects”) and Ser. No.10/813,645 (Hewitt et al., Oct. 27, 2020, “Filamentary Devices forTreatment of Vascular Defects”) disclose a resilient self-expandingpermeable implant having a plurality of elongate filaments which arewoven together. U.S. patent Ser. No. 10/939,914 (Hewitt et al., Mar. 9,2021, “Filamentary Devices for the Treatment of Vascular Defects”)discloses permeable shells made of woven braided mesh with variable meshdensity. U.S. Pat. No. 9,629,635 (Hewitt et al., Apr. 25, 2017, “Devicesfor Therapeutic Vascular Procedures”) discloses an expandablecylindrical structure made of wires and a self-expanding permeable shelllocated at the distal end of the cylindrical structure. U.S. Pat. No.9,078,658 (Hewitt et al., Jul. 14, 2015, “Filamentary Devices forTreatment of Vascular Defects”) discloses a self-expanding resilientpermeable shell having an expanded state with a globular andlongitudinally shortened configuration relative to a radiallyconstrained state, and a plurality of elongate filaments which are woventogether, which define a cavity of the permeable shell. U.S. patentapplication 20200289126 (Hewitt et al., Sep. 17, 2020, “FilamentaryDevices for Treatment of Vascular Defects”) discloses a permeableimplant with a stiff proximal portion that is configured to sit at theneck of an aneurysm.

U.S. patent application 20010034531 (Ho et al., Oct. 25, 2001,“Bioactive Three Loop Coil”) discloses an occlusion subassemblycomprising a base section and a lateral protrusion fixedly attached tothe base section. U.S. patent application 20050142163 (Hunter et al.,Jun. 30, 2005, “Medical Implants and Fibrosis-Inducing Agents”)discloses implants with fibrosis-inducing agents. U.S. patentapplication 20190247053 (Inouye, Aug. 15, 2019, “Occlusive MedicalDevice”) discloses a neck bridge to occlude a heart appendage. U.S.patent application 20190298380 (Inouye et al., Oct. 3, 2019, “OcclusiveMedical Device with Fixation Members”) discloses a neck bridge toocclude a heart appendage. U.S. Pat. No. 6,530,934 (Jacobsen et al.,Mar. 11, 2003, “Embolic Device Composed of a Linear Sequence ofMiniature Beads”) discloses an embolic device comprising a sequence offlexibly interconnected miniature beads. U.S. Pat. No. 6,585,748(Jeffree, Jul. 1, 2003, “Device for Treating Aneurysms”) discloses apermeable intrasaccular bag into which embolic coils are inserted.

U.S. patent Ser. No. 10/405,966 (Johnson, Sep. 10, 2019, “ImplantableIntraluminal Device”) discloses intraluminal stent graft devices whosewalls include compliant channels which allow for fluid communication.U.S. Pat. No. 9,157,174 (Kusleika, Oct. 13, 2015, “Vascular Device forAneurysm Treatment and Providing Blood Flow into a Perforator Vessel”)and U.S. Pat. No. 9,561,122 (Kusleika, Feb. 7, 2017, “Vascular Devicefor Aneurysm Treatment and Providing Blood Flow into a PerforatorVessel”) disclose occlusion devices with heat-set strands. U.S. patentapplication 20190133794 (Kusleika, May 9, 2019, “Methods and Systems forIncreasing a Density of a Region of a Vascular Device”) discloses astent with elastic members and differential porosity. U.S. patentapplication 20150005807 (Lagodzki et al., Jan. 1, 2015, “OcclusionDevice Including Bundle of Occlusion Wires Having Preformed Shapes”)discloses an occlusion device with shape memory wires which expand to apreformed shape. U.S. patent application 20190216468 (Larsen et al.,Jul. 18, 2019, “Occlusive Medical Device”) discloses a neck bridge toocclude a heart appendage. U.S. patent application 20170354402 (Lee etal., Dec. 14, 2017, “Braided Medical Devices”) discloses avaso-occlusive member with helically-wound filaments.

U.S. patent application 20090318948 (Linder et al., Dec. 24, 2009,“Device, System and Method for Aneurysm Embolization”) disclosesdispensing embolic elements freely and randomly within an aneurysmcavity. U.S. patent Ser. No. 10/716,574 (Lorenzo et al., Jul. 21, 2020,“Aneurysm Device and Delivery Method”) discloses a self-expanding braidwith an outer occlusive sack and a segment which inverts into the outerocclusive sack like a tube sock. U.S. patent Ser. No. 10/905,430(Lorenzo et al., Feb. 2, 2021, “Aneurysm Device and Delivery System”)discloses a braid for treating an aneurysm with a radially-expandablesegment which forms an outer occlusive sack and a secondradially-expandable segment which forms an inner occlusive sack. U.S.patent application 20210007755 (Lorenzo et al., Jan. 14, 2021,“Intrasaccular Aneurysm Treatment Device With Varying Coatings”)discloses an intrasaccular implant with an anti-thrombogenic coating.U.S. patent application 20190262123 (Mangiardi, Aug. 29, 2019, “Deviceand Method for Management of Aneurism, Perforation and Other VascularAbnormalities”) discloses a method for treating perforations, fistulas,ruptures, dehiscence and aneurysms.

U.S. patent application 20130245667 (Marchand et al., Sep. 19, 2013,“Filamentary Devices and Treatment of Vascular Defects”) discloses aself-expanding globular shell which is inserted into an aneurysm sac.U.S. patent application 20160249937 (Marchand et al., Sep. 1, 2016,“Multiple Layer Filamentary Devices for Treatment of Vascular Defects”)discloses a self-expanding multi-layer shell which is inserted into ananeurysm sac. U.S. patent application 20180000489 (Marchand et al., Jan.4, 2018, “Filamentary Devices for Treatment of Vascular Defects”)discloses a self-expanding globular shell which is inserted into ananeurysm sac. U.S. Pat. No. 9,597,087 (Marchand et al., Mar. 21, 2017,“Filamentary Devices for Treatment of Vascular Defects”) discloses apermeable shell configured to occlude blood flow. U.S. patent Ser. No.10/610,231 (Marchand et al., Apr. 7, 2020, “Filamentary Devices forTreatment of Vascular Defects”) discloses a self-expanding resilientpermeable shell having a plurality of elongate resilient filaments witha woven structure. U.S. patent application 20200281603 (Marchand et al.,Sep. 10, 2020, “Filamentary Devices for Treatment of Vascular Defects”)discloses a permeable shell with proximal ends of filaments are gatheredby a proximal hub and the distal ends of each of the filaments aregathered by a distal hub.

U.S. patent application 20190254691 (Martin et al., Aug. 22, 2019,“Flexible Intravascular Treatment Devices and Associated Systems andMethods of Use”) discloses stents with a plurality of cells and aplurality of joints between adjacent cells. U.S. patent application20210052278 (Mauger, Feb. 25, 2021, “Vascular Occlusion DevicesUtilizing Thin Film Nitinol Foils”) discloses a deployable occlusiondevice for filling an aneurysm with a first end portion and a second endportion, wherein the first end portion is attached to a supportstructure and the second end portion of the mesh component is a freeend. U.S. patent application 20190209181 (Mayer et al., Jul. 11, 2019,“Medical Device for Treating Vascular Malformations”) discloses ahelical device with a coilable section and a docking section. U.S.patent Ser. No. 10/595,875 (Mayer et al., Mar. 24, 2020, “Device forRestricting Blood Flow to Aneurysms”) and U.S. patent application20200163677 (Mayer et al., May 28, 2020, “Device for Restricting BloodFlow to Aneurysms”) disclose a non-occlusive blood-restricting devicewith a sequence of loops having a gradually decreasing diameter.

U.S. patent application 20180271540 (Merritt et al., Sep. 27, 2018,“Systems and Methods for Embolization of Body Structures”) discloses aself-expanding shell with lobes which is inserted into an aneurysm sac.U.S. patent Ser. No. 10/881,413 (Merritt et al., Jan. 5, 2021, “Systemsand Methods for Embolization of Body Structures”) discloses aself-expanding permeable shell with a plurality ofcircumferentially-arrayed lobes. U.S. patent application 20090112249(Miles et al., Apr. 30, 2009, “Medical Device for Modification of LeftAtrial Appendage and Related Systems and Methods”) discloses collapsibleand self-expanding devices to modify a left atrial appendage. U.S.patent application 20210007754 (Milhous et al., Jan. 14, 2021,“Filamentary Devices for Treatment of Vascular Defects”) discloses apermeable implant having a radially constrained state configured fordelivery within a catheter lumen, an expanded state, and a plurality ofelongate filaments that are woven together. U.S. Pat. No. 9,687,245(Molaei et al., Jun. 27, 2017, “Occlusive Devices and Methods of Use”)discloses an occlusive device with a proximal end, a distal end, and alumen extending between the proximal and distal ends, wherein proximalend has a self-expanding distal section and the distal section has acoil portion.

U.S. patent applications 20180263629 (Murphy et al., Sep. 20, 2018,“Vaso-Occlusive Device and Delivery Assembly”) and 20190254676 (Murphyet al., Aug. 22, 2019, “Vaso-Occlusive Device and Delivery Assembly”)disclose a vaso-occlusive treatment system with multi-layer wires. U.S.patent application 20160213380 (O'Brien, et al., Jul. 28, 2016,“Occlusion Device Having Spherical Secondary Shape and Mandrel forForming Same”) discloses a sphere made from helical memory wire. U.S.patent application 20190083075 (Onushko et al., Mar. 21, 2019,“Occlusive Medical Device with Sealing Member”) disclose a neck bridgeto occlude a heart appendage. U.S. patent application 20060149309 (Paulet al., Jul. 6, 2006, “Inverting Occlusion Devices, Methods, andSystems”) discloses inverted vascular occlusion devices. U.S. patentapplication 20200367900 (Pedroso et al., Nov. 26, 2020, “Layered BraidedAneurysm Treatment Device With Corrugations”) discloses an implant withan open end, a pinched end, and a predetermined shape.

U.S. patent application 20170258473 (Plaza et al., Sep. 14, 2017,“Systems and Methods for Delivery of Stents and Stent-Like Devices”)discloses a self-expanding tubular structure which is inserted into theparent vessel of an aneurysm. U.S. patent application 20190046209 (Plazaet al., Feb. 14, 2019, “Delivery and Detachment Systems and Methods forVascular Implants”) discloses a system for delivering an implant deviceto a vascular site. U.S. patent applications 20060155323 (Porter et al.,Jul. 13, 2006, “Intra-Aneurysm Devices”) and 20190298379 (Porter et al.,Oct. 3, 2019, “Intra-Aneurysm Devices”) disclose an aneurysm occlusiondevice with an upper member in the dome and a lower member in theaneurysm neck. U.S. patent application 20210052279 (Porter et al., Feb.25, 2021, “Intra-Aneurysm Devices”) discloses an aneurysm occlusiondevice with an upper member that sits against the dome of the aneurysm,a lower member that sits in the neck of the aneurysm, and a means ofadjusting the overall dimensions of the device. U.S. Pat. No. 4,638,803(Rand, Jan. 27, 1987, “Medical Apparatus for Inducing Scar TissueFormation in a Body”) discloses a balloon coated withthrombosis-inducing material.

U.S. patent application 20200289124 (Rangwala et al., Sep. 17, 2020,“Filamentary Devices for Treatment of Vascular Defects”) discloses apermeable implant with a stiffer proximal portion that is configured tosit at the neck of an aneurysm, wherein the stiffer proximal portion mayinclude coils, stiffening elements, or reinforcement elements. U.S.patent application 20200038032 (Rhee et al., Feb. 6, 2020, “OcclusiveDevices”) discloses a frame and a mesh component coupled to the frame,wherein mesh component has a first porosity, and the frame has a secondporosity. U.S. patent application 20190209178 (Richter et al., Jul. 11,2019, “Aneurysm Closure Device”) discloses occlusion of an aneurysm neckusing a device with a plurality of self-expanding arms. U.S. patentapplications 20140330299 (Rosenbluth et al., Nov. 6, 2014, “EmbolicOcclusion Device and Method”) discloses a self-expanding globular shellwhich is inserted into an aneurysm sac. U.S. patent application20180303486 (Rosenbluth et al., Oct. 25, 2018, “Embolic Occlusion Deviceand Method”) discloses a self-expanding globular shell which is insertedinto an aneurysm sac plus a coil which extends out from the distal endof the shell. U.S. patent application 20160045201 (Rosenbluth et al.,Feb. 18, 2016, “Blood Flow Disruption Devices and Methods for theTreatment of Vascular Defects”) discloses a blood flow disruption devicewith a porous inner flow disruption element and a porous outer flowdisruption element which coaxially surrounds the inner flow disruptionelement.

U.S. patent application 20090287294 (Rosqueta et al., Nov. 19, 2009,“Braid-Ball Embolic Devices”) discloses “Goodness, Gracious, Great ballsof wire!”. U.S. patent application 20190059907 (Rosqueta et al., Feb.28, 2019, “Devices, Systems, and Methods for the Treatment of VascularDefects”) discloses intrasaccular ribbons for aneurysm occlusion. U.S.patent Ser. No. 10/675,036 (Rosqueta et al., Jun. 9, 2020, “Devices,Systems, and Methods for the Treatment of Vascular Defects”) and U.S.patent application 20200138447 (Rosqueta et al., May 7, 2020, “Devices,Systems, and Methods for the Treatment of Vascular Defects”) disclose anocclusive device that includes a first mesh having an expanded state inwhich it curves about a first axis to form a first band, and a secondmesh having an expanded state in which it curves about a second axisdifferent than the first axis to form a second band. U.S. Pat. No.6,350,270 (Roue, Feb. 26, 2002, “Aneurysm Liner”) discloses an aneurysmliner with an extender inside the liner. U.S. patent application20160022445 (Ruvalcaba et al., Jan. 28, 2016, “Occlusive Device”),patent application 20190343664 (Ruvalcaba et al., Nov. 14, 2019,“Occlusive Device”), and patent Ser. No. 10/736,758 (Ruvalcaba et al.,Aug. 11, 2020, “Occlusive Device”) disclose an aneurysm embolizationdevice with a body having a single, continuous piece of material that isshape set into a plurality of distinct structural components.

U.S. Pat. No. 6,855,153 (Saadat, Feb. 15, 2005, “Embolic Balloon”) andU.S. patent application 20020165572 (Saadat, Nov. 7, 2002, “EmbolicBalloon”) disclose an embolic balloon which aspirates blood whileexpanding. U.S. patent application 20110184451 (Sahl, Jul. 28, 2011,“Membrane Implant for Treatment of Cerebral Artery Aneurysms”) disclosesa cylindrical biocompatible plastic membrane used in combination with astent. U.S. Pat. No. 5,041,090 (Scheglov et al., Aug. 20, 1991,“Occluding Device”) discloses using nested balloons for occlusion. U.S.patent application 20020169473 (Sepetka et al., Nov. 14, 2002, “Devicesand Methods for Treating Vascular Malformations”) discloses occlusivedevices with a primary coil and secondary windings. U.S. patentapplication 20080281350 (Sepetka et al., Nov. 13, 2008, “AneurysmOcclusion Devices”) discloses an (hourglass-shaped) occlusive devicewith a biocompatible matrix. U.S. patent application 20060116709(Sepetka et al., Jun. 1, 2006, “Aneurysm Treatment Devices and Methods”)discloses a device which expands within an aneurysm sac. U.S. Pat. No.8,597,320 (Sepetka et al., Dec. 3, 2013, “Devices and Methods forTreating Vascular Malformations”) discloses an occlusive device with aproximal collar and a distal collar. U.S. patent application 20190274691(Sepetka et al., Sep. 12, 2019, “Occlusive Device”) discloses a tubularbraid that folds inward on itself for aneurysm occlusion.

U.S. patent Ser. No. 10/420,862 (Sharma et al., Sep. 24, 2019, “In-SituForming Foams for Treatment of Aneurysms”) and U.S. patent application20120265287 (Sharma et al., Oct. 18, 2012, “In-Situ Forming Foams forTreatment of Aneurysms”) disclose the use of in-situ forming polymerfoams to treat aneurysms. U.S. patent Ser. No. 10/729,447 (Shimizu etal., Aug. 4, 2020, “Devices for Vascular Occlusion”) discloses anocclusive device, occlusive device delivery system, method of using, andmethod of delivering an occlusive device. U.S. patent application20040254625 (Stephens et al., Dec. 16, 2004, “Inflatable Implant”)discloses an implant that is inflated with filler materials. U.S. patentapplication 20190167272 (Stephens et al., Jun. 6, 2019, “InflatableImplant”) discloses an implant with a low profile when introduced intothe body and a larger profile when it is inflated with one or morefiller materials. U.S. Pat. No. 4,364,392 (Strother et al., Dec. 21,1982, “Detachable Balloon Catheter”) discloses a balloon into which acarrier liquid is pumped. U.S. patent application 20060167494 (Suddaby,Jul. 27, 2006, “Aneurysm Repair Method and Apparatus”) discloses diskspressing against inner and outer sides of an aneurysm neck. U.S. patentapplication 20190201592 (Takahashi et al., Jul. 4, 2019, “Devices andMethods for Aneurysm Treatment”) discloses ways to reduce susceptibilityartifacts in MRA images.

U.S. patent application 20030028209 (Teoh et al., Feb. 6, 2003,“Expandable Body Cavity Liner Device”) discloses an aneurysm liner fortreating aneurysms of various shapes and sizes. U.S. patent application20040098027 (Teoh et al., May 20, 2004, “Expandable Body Cavity LinerDevice”) discloses various aneurysm treatment devices ranging from ballstents to permeable liners. U.S. Pat. No. 7,153,323 (Teoh et al., Dec.26, 2006, “Aneurysm Liner with Multi-Segment Extender”) discloses ananeurysm liner with extender segments inside the liner. U.S. patentapplication 20170354418 (Teoh et al., Dec. 14, 2017, “Vaso-OcclusiveDevice Delivery System”) discloses a vaso-occlusive device deliverysystem with a heat-activated pusher. U.S. Pat. No. 6,958,061 (Truckai etal., Oct. 25, 2005, “Microspheres with Sacrificial Coatings forVaso-Occlusive Systems”) discloses using a fluid to deliver microspheresfor vascular occlusion. U.S. Pat. No. 4,341,218 (U, Jul. 27, 1982,“Detachable Balloon Catheter”) discloses a balloon with a hollowcylinder fastened at the neck of the balloon. U.S. Pat. No. 5,935,148(Villar et al., Aug. 10, 1999, “Detachable, Varying Flexibility,Aneurysm Neck Bridge”) and U.S. Pat. No. 6,063,104 (Villar et al., May16, 2000, “Detachable, Varying Flexibility, Aneurysm Neck Bridge”)disclose an aneurysm neck bridge with varying flexibility. U.S. patentapplication 20190269533 (Vong et al., Sep. 5, 2019, “Stent and StentDelivery Device”) discloses a stent made from a single woven nitinolwire.

U.S. patent application 20110196413 (Wallace et al., Aug. 11, 2011,“System and Method for Retaining Vaso-Occlusive Devices within anAneurysm”) discloses an occlusive mesh made from a shape-memory alloy.U.S. patent applications 20170086851 (Wallace et al., Mar. 30, 2017,“Vaso-Occlusive Devices and Methods of Use”) and 20190201000 (Wallace etal., Jul. 4, 2019, “Vaso-Occlusive Devices”) disclose a vaso-occlusivedelivery system with a pusher. U.S. patent Ser. No. 10/383,635 (Wallaceet al., Aug. 20, 2019, “Vaso-Occlusive Devices and Methods of Use”) andU.S. patent application 20180250013 (Wallace et al., Sep. 6, 2018,“Vaso-Occlusive Devices Including a Friction Element”) disclose avaso-occlusive system with a pusher to deliver soft embolic members.U.S. patent application 20200187952 (Walsh et al., Jun. 18, 2020,“Intrasaccular Flow Diverter for Treating Cerebral Aneurysms”) disclosesflow diverters with a stabilizing frame for anchoring the implant and anoccluding element for diverting blood flow from the aneurysm neck. U.S.patent application 20210022765 (Walzman, Jan. 28, 2021, “CoatedEndovascular Intrasaccular Occlusion Device”) discloses an endovasculartreatment mesh device with an amorphous hydrogel layer. U.S. patent Ser.No. 10/398,441 (Warner et al., Sep. 3, 2019, “Vascular Occlusion”)discloses an aneurysm occlusion system which includes a containment bag,a pusher, and a stopper ring. U.S. patent application 20030212419 (West,Nov. 13, 2003, “Aneurysm Embolization Device and Deployment System”)discloses an aneurysm embolization device with a headpiece and aplurality of spherical members.

U.S. Pat. No. 7,083,643 (Whalen et al., Aug. 1, 2006, “Methods forTreating Aneurysms”) discloses filling an aneurysm sac with a fluidcomposition which solidifies in situ. U.S. patent Ser. No. 10/898,199(Wilson et al., Jan. 26, 2021, “Expandable Implant and Implant System”)discloses an expandable implant comprising a chain or linked sequence ofexpandable polymer foam elements. U.S. patent application 20200367897(Wolfe et al., Nov. 26, 2020, “Systems and Methods for TreatingAneurysms”) discloses an inverted mesh tube having an outer layer and aninner layer, wherein the outer layer transitions to the inner layer atan inversion fold. U.S. patent application 20210045750 (Wolf et al.,Feb. 18, 2021, “Systems and Methods for Treating Aneurysms”) disclosesan implantable vaso-occlusive device including a proximal end configuredto seat against the aneurysm adjacent the neck of the aneurysm and adistal end configured to extend in the sac and away from the neck of theaneurysm. U.S. patent application 20200367893 (Xu et al., Nov. 26, 2020,“Layered Braided Aneurysm Treatment Device”) discloses an implant withtwo layers of tubular braid set into a predetermined shape. U.S. patentapplication 20200367896 (Zaidat et al., Nov. 26, 2020, “Systems andMethods for Treating Aneurysms”) discloses an occlusion element with afirst tubular mesh having a first end and a second end coupled togetherat a proximal end of the occlusion element, wherein an intermediateportion of the first tubular mesh includes a substantially 180 degreeturn. U.S. patent Ser. No. 10/383,749 (Zhou et al., Aug. 20, 2019,“Stent and Method of Inserting a Stent into a Delivery Catheter”)discloses a stent which is radially contractable from a fully radiallyexpanded state to a radially contracted state via elongation of theframe.

SUMMARY OF THE INVENTION

Disclosed herein are innovative designs for parent-vessel andintrasacular devices for occluding cerebral aneurysms, includingirregularly-shaped and wide-neck aneurysms. In an example, anintrasacular aneurysm occlusion device can be a peanut, hourglass,and/or hyperbolic shaped mesh which is inserted and expanded within ananeurysm sac. The proximal lobe of the device reduces blood flow intothe sac through the aneurysm neck and the distal lobe of the devicecontacts the dome of the sac so as to keep the proximal lobe fromshifting. The narrow center portion of the peanut, hourglass, orhyperbolic mesh can bend so that the device at least partially conformsto the interior of an irregularly-shaped aneurysm sac. In an example,this device can further comprise a proximal bowl-shaped mesh whichcovers the aneurysm neck. The proximal lobe of the peanut, hourglass,and/or hyperbolic-shaped mesh can be nested within the distal-facingconcavity of the bowl-shaped mesh. The bowl-shaped mesh further reducesblood flow into the sac through the aneurysm neck. More generally, ananeurysm occlusion device can comprise a distal convex mesh which isnested within the concavity of a proximal bowl-shaped mesh.

BRIEF INTRODUCTION TO THE FIGURES

FIG. 1 shows a parent-vessel aneurysm occlusion device whereinelectromagnetic energy moves a planar mesh to one side of a tubularmesh.

FIG. 2 shows a parent-vessel aneurysm occlusion device wherein inflationof a balloon pushes a planar mesh to one side of a tubular mesh.

FIG. 3 shows a parent-vessel aneurysm occlusion device wherein apartial-cylindrical mesh is rotated to one side of a tubular mesh.

FIG. 4 shows a parent-vessel aneurysm occlusion device wherein apartial-cylindrical mesh is removed from a tubular mesh.

FIG. 5 shows a parent-vessel aneurysm occlusion device with alow-porosity helical strip.

FIG. 6 shows a parent-vessel aneurysm occlusion device whereinapplication of electromagnetic energy causes wires, struts, or bands topartially detach from a tubular mesh.

FIG. 7 shows a parent-vessel aneurysm occlusion device with undulating,contracting longitudinal wires (or bands).

FIG. 8 shows a parent-vessel aneurysm occlusion device wherein a gapbetween circumferential wires (or bands) can be closed.

FIG. 9 shows a parent-vessel aneurysm occlusion device with a pluralityof proximal and distal detachment locations on longitudinal wires orbands.

FIG. 10 shows a parent-vessel aneurysm occlusion device with a pluralityof removable longitudinal strips along a tubular mesh.

FIG. 11 shows an intrasacular aneurysm occlusion device with ahalf-torus mesh and coils.

FIG. 12 shows an intrasacular aneurysm occlusion device with a toroidalmesh and coils.

FIG. 13 shows an intrasacular aneurysm occlusion device with abowl-shaped mesh and coils.

FIG. 14 shows an intrasacular aneurysm occlusion device with a proximalhalf-torus mesh and a distal flexible net.

FIG. 15 shows an intrasacular aneurysm occlusion device with a proximaltoroidal mesh and a distal flexible net.

FIG. 16 shows an intrasacular aneurysm occlusion device with a proximalbowl-shaped mesh and a distal flexible net.

FIG. 17 shows an intrasacular aneurysm occlusion device comprising a netor mesh with a flexible distal portion.

FIG. 18 shows an intrasacular aneurysm occlusion device with a resilientmesh (e.g. ring stent) around a central circumference of a net.

FIG. 19 shows an intrasacular aneurysm occlusion device with a disk orball-shaped mesh inside a net.

FIG. 20 shows an intrasacular aneurysm occlusion device wherein a meshis radially-expanded and then longitudinally-collapsed in an aneurysm.

FIG. 21 shows an intrasacular aneurysm occlusion device with a valve ina half-torus mesh through which embolic members are inserted.

FIG. 22 shows an intrasacular aneurysm occlusion device with a valve intoriodal mesh through which embolic members are inserted.

FIG. 23 shows an intrasacular aneurysm occlusion device with a valve inbowl-shaped mesh through which embolic members are inserted.

FIG. 24 shows an intrasacular aneurysm occlusion device with a valve inhyperbolic-shaped (e.g. hourglass shaped) mesh through which embolicmembers are inserted.

FIG. 25 shows an intrasacular aneurysm occlusion device with an innerconvex mesh, an outer convex mesh, and a valve in the outer convex meshthrough which embolic members are inserted.

FIG. 26 shows an intrasacular aneurysm occlusion device with a metalmesh, a polymer net around the metal mesh, and a valve in the polymernet through which embolic members are inserted.

FIG. 27 shows an intrasacular aneurysm occlusion device with a proximalbowl-shaped mesh and a distal globular mesh.

FIG. 28 shows an intrasacular aneurysm occlusion device with a proximalconvex mesh and a distal convex mesh.

FIG. 29 shows an intrasacular aneurysm occlusion device with a proximaldisk mesh and a distal disk mesh.

FIG. 30 shows an intrasacular aneurysm occlusion device comprising adouble-layer bowl-shaped mesh with a valve through which embolic membersare inserted.

FIG. 31 shows an intrasacular aneurysm occlusion device comprising aproximal bowl-shaped mesh, a distal flexible net inside the concavity ofthe bowl, and a valve through which embolic members are inserted.

FIG. 32 shows an intrasacular aneurysm occlusion device comprising aproximal bowl-shaped mesh, a distal flexible net around the concavity ofthe bowl, and a valve through which embolic members are inserted.

FIG. 33 shows a tri-leaflet valve through which embolic members areinserted into an aneurysm sac.

FIG. 34 shows an elastic annular valve through which embolic members areinserted into an aneurysm sac.

FIG. 35 shows a rotational valve through which embolic members areinserted into an aneurysm sac.

FIG. 36 shows a sliding valve through which embolic members are insertedinto an aneurysm sac.

FIG. 37 shows a pivoting valve through which embolic members areinserted into an aneurysm sac.

FIG. 38 shows a plug-mechanism valve through which embolic members areinserted into an aneurysm sac.

FIG. 39 shows a “string-of-pearls” embolic member comprising embolicpearls (e.g. bead-like polymer, hydrogel, or metal masses) connected bya flexible longitudinal string (e.g. a flexible strand, thread,filament, tube, or wire).

FIG. 40 shows a “string-of-pearls” embolic member wherein pearls in adistal portion of a longitudinal series are father apart than pearls ina proximal portion of the longitudinal series.

FIG. 41 shows a “string-of-pearls” embolic member wherein pearls in adistal portion of the longitudinal series are larger than pearls in aproximal portion of the longitudinal series.

FIG. 42 shows a “string-of-pearls” embolic member with an undulating,sinusoidal, or helical string.

FIG. 43 shows a “string-of-pearls” embolic member with soft,compressible embolic pearls.

FIG. 44 shows a “string-of-pearls” embolic member wherein embolic pearlsare connected by two flexible longitudinal strings.

FIG. 45 shows an aneurysm occlusion device comprising a globular mesh inan aneurysm sac and a stent in the parent vessel, wherein the mesh andthe stent are connected.

FIG. 46 shows an aneurysm occlusion device comprising a collapsedglobular mesh in an aneurysm sac and a stent in the parent vessel.

FIG. 47 shows a parent-vessel aneurysm occlusion device with removablepartially-circumferential meshes inside a tubular mesh.

FIG. 48 shows a first example of a parent-vessel aneurysm occlusiondevice with movable partially-circumferential meshes inside a tubularmesh.

FIG. 49 shows a second example of a parent-vessel aneurysm occlusiondevice with movable partially-circumferential meshes inside a tubularmesh.

FIG. 50 shows a parent-vessel aneurysm occlusion device comprising alongitudinal tubular mesh with an adjustable spiral cross-sectionalperimeter.

FIG. 51 shows an intrasacular aneurysm occlusion device with nestedproximal and distal umbrella-shaped meshes.

FIG. 52 shows an intrasacular aneurysm occlusion device with a proximalbowl-shaped mesh and a distal umbrella-shaped mesh which overlap.

FIG. 53 shows an intrasacular aneurysm occlusion device with nestedproximal and distal bowl-shaped meshes.

FIG. 54 shows an intrasacular aneurysm occlusion device with a pluralityof embolic masses which slide along a wire.

FIG. 55 shows an intrasacular aneurysm occlusion device comprising: abowl-shaped mesh through which coils are inserted into an aneurysm sac,wherein the bowl is formed by pinching the ends of a tubular mesh andthen moving these ends together; a distal-facing lumen within which thedistal end of the tubular mesh is pinched; and a proximal-facing lumenwithin which the proximal end of the tubular mesh is pinched.

FIG. 56 shows an intrasacular aneurysm occlusion device comprising: abowl-shaped mesh through which coils are inserted into an aneurysm sac,wherein the bowl is formed by pinching the ends of a tubular mesh andthen moving these ends together; a proximal-facing lumen within whichthe distal end of the tubular mesh is pinched; and a proximal-facinglumen within which the proximal end of the tubular mesh is pinched.

FIG. 57 shows an intrasacular aneurysm occlusion device comprising: abowl-shaped mesh through which coils are inserted into an aneurysm sac,wherein the bowl is formed by pinching the ends of a tubular mesh andthen moving these ends together; a proximal-facing lumen within whichthe distal end of the tubular mesh is pinched; and a distal-facing lumenwithin which the proximal end of the tubular mesh is pinched.

FIG. 58 shows an intrasacular aneurysm occlusion device comprising: abowl-shaped mesh through which coils are inserted into an aneurysm sac,wherein the bowl is formed by pinching the ends of a tubular mesh andthen moving these ends together; a distal-facing lumen within which thedistal end of the tubular mesh is pinched; and a distal-facing lumenwithin which the proximal end of the tubular mesh is pinched.

FIG. 59 shows an intrasacular aneurysm occlusion device comprising: abowl-shaped mesh through which coils are inserted into an aneurysm sac,wherein the bowl is formed by pinching the ends of a tubular mesh andthen moving these ends together; a distal-facing lumen within which theproximal and distal ends of the tubular mesh are pinched.

FIG. 60 shows an intrasacular aneurysm occlusion device comprising: abowl-shaped mesh through which coils are inserted into an aneurysm sac,wherein the bowl is formed by pinching the ends of a tubular mesh andthen moving these ends together; a proximal-facing lumen within whichthe proximal and distal ends of the tubular mesh are pinched.

FIG. 61 shows an intrasacular aneurysm occlusion device comprising apeanut or hourglass shaped mesh.

FIG. 62 shows an intrasacular aneurysm occlusion device comprising adistal peanut or hourglass shaped mesh and a proximal bowl-shaped mesh.

FIG. 63 shows an intrasacular aneurysm occlusion device comprising adistal convex mesh and a proximal bowl-shaped mesh.

DETAILED DESCRIPTION OF THE FIGURES

FIG. 1 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a tubular mesh 101 which isconfigured to be inserted into the parent blood vessel of an aneurysmand span the aneurysm neck; a planar mesh 102 in the interior cavity ofthe tubular mesh; and an electromagnetic energy emitter 103, whereintransmission of electromagnetic energy from the emitter to the planarmesh causes the planar mesh to move (e.g. bend, curve, shift, and/orexpand) toward a selected portion of the circumferential perimeter (e.g.toward a selected side) of the tubular mesh which is closest to theaneurysm neck. This selectively decreases the porosity of the portion ofthe device which is closest to the aneurysm neck. The upper half of FIG.1 shows this device at a first point in time before electromagneticenergy has been applied to the planar mesh. The lower half of FIG. 1shows this device at a second point in time after electromagnetic energyhas been applied to the planar mesh and caused the planar mesh to curvetoward a selected portion (e.g. a selected side) of the tubular mesh.

In an example, a tubular mesh can be cylindrical. In an example, atubular mesh can be a metal stent. In an example, a tubular mesh can bea polymer stent. In an example, a tubular mesh can be cut, braided, or3D printed. In an example, a tubular mesh can be an expandable wireframe. In an example, a tubular mesh can self-expand when released froma catheter. In an example, a tubular mesh can further compriseradio-opaque sections or markers. In an example, a planar mesh can becentrally located within the interior cavity of a tubular mesh. In anexample, a planar mesh can span a central diameter of the interiorcavity of a tubular mesh. In an example, the sides of a planar mesh canbe attached to the interior surface of a tubular mesh. In an example,the porosity of a planar mesh can be lower than the porosity of atubular mesh. In an example, a planar mesh can be radio-opaque. In anexample, a planar mesh can comprise a polymer mesh on a wire frame.

In an example, a planar mesh can be made from shape memory materialwhose configuration is changed by the application of electromagneticenergy. In an example, a central portion of a planar mesh can move (e.g.bend, curve, and/or expand) toward a selected side of the tubular meshwhen electromagnetic energy is applied. In an example, the direction inwhich a planar mesh moves can be selected (remotely) by a deviceoperator after the device has been positioned within the parent bloodvessel of an aneurysm. In an example, an electromagnetic energy emittercan be located and/or controlled by the operator from a locationexternal to a person's body. In an example, an electromagnetic energyemitter can be in electromagnetic communication with the planar mesh viaa wire. In an example, the planar mesh can be curved in a convex mannerby application of a first pattern of electromagnetic energy or curved ina concave manner by application of a second pattern of electromagneticenergy, wherein the pattern of electromagnetic energy is selected by adevice operator.

In an example, a planar mesh can have a first (generally flat)configuration in which it is centrally located within a tubular mesh anda second (arcuate) configuration in which it has been moved (e.g. bent,curved, and/or expanded) toward the side of the tubular mesh which isclosest to the aneurysm neck. In an example, a planar mesh can be movedfrom its first configuration to its second configuration by theapplication of electromagnetic energy. In an example, a planar mesh cansubstantially overlap, span, and/or conform to a selected side of atubular mesh when the planar mesh is in its second configuration. In anexample, a planar mesh can have a quarter-cylinder shape in its secondconfiguration. In an example, a planar mesh can overlap, span, and/orconform to between 20% and 40% of the circumferential perimeter of atubular mesh when the planar mesh is in its second configuration. In anexample, a planar mesh can have a half-cylinder shape in its secondconfiguration. In an example, a planar mesh can overlap, span, and/orconform to between 33% and 66% of the circumferential perimeter of atubular mesh when the planar mesh is in its second configuration.

In the example shown in FIG. 1, a device includes a tubular mesh and asingle interior mesh in the interior cavity of the tubular mesh. In avariation on this example, a device can include a tubular mesh and aplurality of interior meshes in the interior cavity of the tubular mesh.In an example, one or more of a plurality of interior meshes can beselected to be moved by a device operator. In an example, one or moreselected interior meshes can be moved by a device operator toward theside of the device which is closest to the aneurysm after the device hasbeen inserted into in the parent blood vessel. In an example, theconcavity and/or convexity of one or more interior meshes can beselectively and remotely adjusted by a device operator after the devicehas been inserted into a parent blood vessel so as to decrease theporosity of the side ofthe device which is closest to an aneurysm neck.

FIG. 2 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a tubular mesh 201 which isconfigured to be inserted into the parent blood vessel of an aneurysmand to span the aneurysm neck; a planar mesh 202 in the interior cavityof the tubular mesh; a first longitudinal balloon 203 between a firstside of the planar mesh and the tubular mesh; and a second longitudinalballoon 204 between a second side of the planar mesh and the tubularmesh, wherein inflation of the second longitudinal balloon pushes theplanar mesh toward a selected portion of the circumferential perimeter(e.g. toward a selected side) of the tubular mesh which is closest tothe aneurysm neck. This selectively decreases the porosity of theportion of the device which is closest to the aneurysm neck. The upperhalf of FIG. 2 shows this device at a first point in time before thesecond balloon has been inflated. The lower half of FIG. 2 shows thisdevice at a second point in time after the first balloon has beenremoved and the second balloon has been inflated. After this, the secondballoon is deflated and also removed.

In an example, a tubular mesh can be cylindrical. In an example, atubular mesh can be a metal stent. In an example, a tubular mesh can bea polymer stent. In an example, a tubular mesh can be cut, braided, or3D printed. In an example, a tubular mesh can be an expandable wireframe. In an example, a tubular mesh can self-expand when released froma catheter. In an example, a tubular mesh can further compriseradio-opaque sections or markers. In an example, a planar mesh can becentrally located within the interior cavity of a tubular mesh. In anexample, a planar mesh can span a central diameter of the interiorcavity of a tubular mesh. In an example, the side of a planar mesh canbe attached to the interior of the tubular mesh. In an example, theporosity of the planar mesh can be lower than the porosity of thetubular mesh. In an example, a planar mesh can be radio-opaque. In anexample, a planar mesh can comprise a polymer mesh on a wire frame.

In an example, a central portion of a planar mesh can be pushed (e.g.bent, curved, and/or expanded) toward a selected side of the tubularmesh when the balloon closer to the aneurysm neck is removed and theballoon farther from the aneurysm neck is inflated. In an example, aplanar mesh can have a first configuration in which it is centrallylocated within the tubular mesh and a second configuration in which itcurves toward the side of the tubular mesh which is closest to theaneurysm neck. In an example, a planar mesh can be moved from its firstconfiguration to its second configuration by removal of one balloon andinflation of the other balloon.

In an example, a planar mesh can substantially overlap, span, and/orconform to a selected side of a tubular mesh when the planar mesh is inits second configuration. In an example, a planar mesh can overlap,span, and/or conform to between 20% and 40% of the circumferentialperimeter of a tubular mesh when the planar mesh is in its secondconfiguration. In an example, a planar mesh can overlap, span, and/orconform to between 33% and 66% of the circumferential perimeter of atubular mesh when the planar mesh is in its second configuration. In anexample, a planar mesh can be substantially flat in its firstconfiguration and can be a section of a cylinder (e.g. a half cylinder)in its second configuration.

FIG. 3 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a cylindrical mesh 301 whichis configured to be inserted into the parent blood vessel of an aneurysmand to span the aneurysm neck; a partial-cylindrical mesh 302 inside thecylindrical mesh, wherein the partial-cylindrical mesh can be rotatedrelative to the cylindrical mesh, wherein a first portion of thecircumferential perimeter of the device where the partial cylindricalmesh and the cylindrical mesh overlap has a first porosity level,wherein a second portion of the circumferential perimeter of the devicewhere the partial cylindrical mesh and the cylindrical mesh do notoverlap has a second porosity level, wherein the second porosity levelis less than the first porosity level, and wherein thepartial-cylindrical mesh is rotated after insertion of the device intothe parent blood vessel so that the first portion is closer to theaneurysm neck than the second portion. The upper half of FIG. 3 showsthis device at a first point in time before the partial-cylindrical meshhas been rotated. The lower half of FIG. 3 shows this device at a secondpoint in time after the partial-cylindrical mesh has been rotated.

In an example, a cylindrical mesh can be a metal stent. In an example, acylindrical mesh can be a polymer stent. In an example, a cylindricalmesh can be cut, braided, or 3D printed. In an example, a cylindricalmesh can be an expandable wire frame. In an example, a cylindrical meshcan self-expand when released from a catheter. In an example, acylindrical mesh can further comprise radio-opaque sections or marker.In an example, the porosity of the partial-cylindrical planar mesh canbe lower than the porosity of the cylindrical mesh. In an example, thepartial-cylindrical planar mesh can comprise a polymer mesh on a wireframe. In an example, a partial-cylindrical mesh can be radio-opaque. Inan example, a partial-cylindrical mesh can be a quarter cylinder. In anexample, a partial-cylindrical mesh can overlap between 20% and 40% ofthe circumferential perimeter of the cylindrical mesh. In an example, apartial-cylindrical mesh can be a half cylinder. In an example, thepartial-cylindrical mesh can overlap between 33% and 66% of thecircumferential perimeter of the cylindrical mesh.

In an example, rotation of a partial-cylindrical mesh can be remotelycontrolled by a device operator from a location external to a person'sbody. In an example, a partial-cylindrical mesh can be rotated by adevice operator by rotating a catheter and/or guide wire. In an example,this device can further comprise an electromagnetic actuator whichrotates the partial-cylindrical mesh relative to the cylindrical mesh,wherein this actuator is remotely controlled by the device operator.

FIG. 4 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: an outer cylindrical mesh 401which is configured to be inserted into the parent blood vessel of ananeurysm and span the aneurysm neck; an inner cylindrical mesh 403 whichis inside the outer cylindrical mesh; a first partial-cylindrical mesh402 (e.g. a half-cylinder mesh or quarter-cylinder mesh) which isbetween the outer cylindrical mesh and the inner cylindrical mesh; and asecond partial-cylindrical mesh 403 (e.g. a half-cylinder mesh orquarter-cylinder mesh) which is between the outer cylindrical mesh andthe inner cylindrical mesh, wherein the first partial-cylindrical iscloser to the aneurysm neck than the second partial-cylindrical mesh,and wherein the second partial-cylindrical mesh is removed from thedevice after the device has been inserted into the parent blood vessel.This causes the side of the device which is closer to the aneurysm neckto have a lower porosity than the side of the device which is fartherfrom the aneurysm neck. The upper half of FIG. 4 shows this device at afirst point in time before the second partial-cylindrical mesh has beenremoved from the device. The lower half of FIG. 4 shows this device at asecond point in time after the second partial-cylindrical mesh has beenremoved from the device.

In an example, an outer and/or inner cylindrical mesh can be made frommetal. In an example, an outer and/or inner cylindrical mesh can be madefrom a polymer. In an example, an outer and/or inner cylindrical meshcan be cut, braided, or 3D printed. In an example, an outer and/or innercylindrical mesh can be an expandable wire frame. In an example, anouter and/or inner cylindrical mesh can self-expand when released from acatheter. In an example, an outer and/or inner cylindrical mesh canfurther comprise radio-opaque sections or markers. In an example, theporosity of a partial-cylindrical mesh can be lower than the porosity ofan outer and/or inner cylindrical mesh. In an example, apartial-cylindrical mesh can be radio-opaque. In an example, apartial-cylindrical mesh can comprise a polymer mesh on a wire frame. Inan example, a partial-cylindrical mesh can be a half cylinder. In anexample, a partial-cylindrical mesh can overlap between 33% and 66% ofthe circumferential perimeter of the outer cylindrical mesh. In anexample, a partial-cylindrical mesh can be a quarter cylinder. In anexample, a partial-cylindrical mesh can overlap between 20% and 40% ofthe circumferential perimeter of the outer cylindrical mesh.

In an example, one or more of a plurality of partial-cylindrical meshescan be selected, detached, and removed from the device by a deviceoperator after the device has been inserted into a parent blood vessel.In an example, a device operator can select which partial-cylindricalmeshes to remove by observing, via medical imaging, which are farthestfrom the aneurysm neck after insertion of the device into the parentblood vessel. In an example, a device operator can detach selectedpartial-cylindrical meshes by applying electromagnetic energy to them,thereby melting connections between the partial-cylindrical meshes andthe outer and/or inner cylindrical meshes. In an example, selectedpartial-cylindrical meshes can then be removed by sliding them out frombetween the outer and inner cylindrical meshes.

In an example, a device for occluding a cerebral aneurysm can comprise:an outer cylindrical mesh which is configured to be inserted into theparent blood vessel of an aneurysm and span the aneurysm neck; an innercylindrical mesh which is inside the outer cylindrical mesh; and aplurality of longitudinal strips between the outer cylindrical mesh andthe inner cylindrical mesh. In an example, a first set of longitudinalstrips is closer to the aneurysm neck than a second set of longitudinalstrips. In an example, the second set of longitudinal strips can beremoved from the device after the device has been inserted into theparent blood vessel. In an example, a second set of longitudinal stripscan be selected by the device operator based on medical imaging. In anexample, a second set of longitudinal strips can be removed from thedevice and from the person's body by a device operator. This leaves thedevice with lower porosity along the side which is closest to theaneurysm neck.

FIG. 5 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a tubular mesh 503 which isconfigured to be inserted into a parent blood vessel, wherein the parentblood vessel has an aneurysm 501 and one or more branching vessels 502,wherein the tubular mesh further comprises at least one low-porosityhelical strip 504 whose porosity is lower than the average porosity ofthe tubular mesh, wherein the tubular mesh is configured to be moved sothat the helical strip spans at least a portion of the aneurysm neck butdoes not span the entrance to the one or more branching vessels. Theupper half of FIG. 5 shows this device at a first point in time beforeit has been moved so that the helical strip spans the aneurysm neck. Thelower half of FIG. 5 shows this device at a second point in time afterit has been moved so that the helical strip does span the aneurysm neck.

In this example, a device includes a double helix (with two low-porosityhelical strips). In an example, a device can have just one low-porosityhelical strip. In an example, a device can be moved longitudinally inorder to align a low-porosity helical strip with an aneurysm neck (andmisalign the strip with the entrances to one or more branching vessels).In a variation on this example, a device can have a longitudinal seriesof low-porosity rings or bands, wherein the device can be movedlongitudinally in order to align a low-porosity ring or band with ananeurysm neck (and misalign low-porosity rings or bands with theentrances to one or more branching vessels).

In an example, a device can be rotated in order to align a low-porosityhelical strip with an aneurysm neck (and misalign the strip with theentrances to one or more branching vessels). In an example, rotation ofthe device can be remotely controlled by a device operator from alocation external to a person's body. In an example, the device can berotated by a device operator by rotating a catheter and/or guide wire.In an example, this device can further comprise an electromagneticactuator which rotates the low-porosity helical strip, wherein thisactuator is remotely controlled by the device operator.

FIG. 6 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a tubular mesh (601) which isconfigured to be inserted into the parent blood vessel of an aneurysm, afirst longitudinal series of wires, struts, and/or bands (including602), and a second longitudinal series of wires, struts, and/or bands(including 603), wherein the second longitudinal series of wires,struts, and/or bands is connected to the tubular mesh by a plurality ofconnections (including 604 and 605), and wherein application ofelectromagnetic energy to selected connections causes a selected sub-setof the second longitudinal series of wires, struts, or bands to at leastpartially detach from the tubular mesh and to contract over the portionof the tubular mesh which is configured to be closest to the aneurysmneck, thereby decreasing the porosity of portion of the tubular meshwhich spans the aneurysm neck.

The upper half of FIG. 6 shows this device at a first point in time,before electromagnetic energy has been applied to selected connectionsand a selected sub-set of the second longitudinal series of wires,struts, or bands has partially detached from the tubular mesh andcontracted over a side of the tubular mesh. The lower half of FIG. 6shows this device at a second point in time, after electromagneticenergy has been applied to selected connections and a selected sub-setof the second longitudinal series of wires, struts, or bands haspartially detached from the tubular mesh and contracted over a side ofthe tubular mesh.

In an example, a tubular mesh can be cylindrical. In an example, atubular mesh can be a metal stent. In an example, a tubular mesh can bea polymer stent. In an example, a tubular mesh can be a cut, braided, or3D printed. In an example, a tubular mesh can be an expandable wireframe. In an example, a tubular mesh can self-expand when released froma catheter. In an example, a tubular mesh can further compriseradio-opaque sections or markers. In an example, wires, struts, and/orbands in a second longitudinal series of wires, struts, and/or bands canbe undulating, sinusoidal, and/or serpentine. In an example, undulationsof a wire, strut, and/or band can be closer together after the wire,strut, and/or band has been (partially) detached and contracted. In anexample, a wire, strut, and/or band can be made from a shape memorymaterial so that the wire, strut, and/or band self-contracts when it is(partially) detached from a tubular mesh. In an example, a tubular meshcan have inner and outer layers. In an example, wires, struts, and/orbands in a second longitudinal series can move (e.g. slide and contract)between these inner and outer layers.

In an example, wires, struts, and/or bands in a second longitudinalseries of wires, struts, and/or bands can have a first configuration inwhich they span the entire circumference of a tubular mesh. In anexample, selected wires, struts, and/or bands in a second longitudinalseries of wires, struts, and/or bands can have a second (contracted)configuration in which they span only a portion of the circumference ofa tubular mesh. In an example, selected wires, struts, and/or bands in asecond longitudinal series of wires, struts, and/or bands can spanbetween 20% and 40% of the circumference of a tubular mesh in theirsecond (contracted) configuration. In an example, selected wires,struts, and/or bands in a second longitudinal series of wires, struts,and/or bands can span between 33% and 66% of the circumference of atubular mesh in their second (contracted) configuration.

In an example, selected wires, struts, and/or bands in a secondlongitudinal series of circumferential wires, struts, and/or bands canbe changed from their first configurations to their secondconfigurations by selectively (partially) detaching them from thetubular mesh. In an example, they can be selectively detached from thetubular mesh by selectively melting the connections between them and thetubular mesh by the selective application of electromagnetic energy. Inan example, a device operator can selectively decrease the porosity ofthe side of the device closest to the aneurysm neck by selectivelymelting connections of circumferential wires, struts, and/or bands onthe side farthest from the aneurysm neck. In an example, selected wires,struts, and/or bands in a second longitudinal series of circumferentialwires, struts, and/or bands can be made from shape memory material,wherein they are changed from their first configurations by first(partially) detaching them from the tubular mesh and then applyingelectromagnetic energy which contracts them.

FIG. 7 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a tubular mesh 701 which isconfigured to be inserted into the parent blood vessel of an aneurysm; alongitudinal series of circumferential wires (or bands) including 702;and a plurality of undulating longitudinal wires (or bands) including703, 704, and 705, wherein the plurality of undulating longitudinalwires have a first configuration in which undulations of different wireshave the same inter-undulation distance, wherein the plurality ofundulating longitudinal wires have a second configuration in whichundulations of different wires have different inter-undulationdistances, and wherein the plurality of undulating longitudinal wiresare changed from their first configuration to their second configurationby the application of electromagnetic energy to a selected subset of theplurality of undulating longitudinal wires. The upper half of FIG. 7shows this device at a first point in time before electromagnetic energyhas been applied to a selected subset of the plurality of undulatinglongitudinal wires. The lower half of FIG. 7 shows this device at asecond point in time after electromagnetic energy has been applied to aselected subset of the plurality of undulating longitudinal wires,thereby reducing the porosity of the side of the device which is closestto the aneurysm neck.

In an example, a device operator can selectively reduce the distancesbetween undulations in one or more undulating longitudinal wires on aside of the device which is closest to the aneurysm neck in order todecrease the porosity of the side of the device which is closest to theaneurysm neck. In an example, a tubular mesh can be cylindrical. In anexample, a tubular mesh can be a metal stent. In an example, a tubularmesh can be a polymer stent. In an example, a tubular mesh can be a cut,braided, or 3D printed. In an example, a tubular mesh can be anexpandable wire frame. In an example, a tubular mesh can self-expandwhen released from a catheter. In an example, a tubular mesh can furthercomprise radio-opaque sections or markers. In an example, undulatinglongitudinal wires can be sinusoidal and/or serpentine. In an example,undulating longitudinal wires can be made from a shape memory materialwhose undulations contract when exposed to electromagnetic energy.

FIG. 8 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a tubular mesh 801 which isconfigured to be inserted into the parent blood vessel of an aneurysm; alongitudinal series of circumferential wires (or bands) including 802and 803; and a catheter 804 for delivery of embolic coils (or otherembolic material) into the aneurysm, wherein the device has a firstconfiguration in which there is a gap between wires (or bands) in thelongitudinal series of circumferential wires (or bands) through whichcatheter 804 extends into the aneurysm, wherein the device has a secondconfiguration in which the catheter has been removed from the gap andthe gap between circumferential wires (or bands) has been closed, andwherein the device is changed from the first configuration to the secondconfiguration by moving wires in the longitudinal series ofcircumferential wires (or bands) closer together.

The upper half of FIG. 8 shows this device at a first point in timewherein there is a gap between wires (or bands) in the longitudinalseries of circumferential wires (or bands) through which a catheter (orother lumen) extends into the aneurysm. The lower half of FIG. 8 showsthis device at a second point in time wherein the catheter (or otherlumen) has been removed from the gap and the gap between circumferentialwires (or bands) has been closed. In an example, the device can bedeployed in the following steps: (a) the device in its firstconfiguration is inserted into and expanded within the parent bloodvessel of an aneurysm; (b) embolic coils or other embolic material isinserted into the aneurysm sac through the catheter which extendsthrough the gap in the wall of the device; (c) the catheter is withdrawnfrom the gap and from the person's body; and (d) the gap is then closedby moving wires (or bands) in the longitudinal series of circumferentialwires (or bands) closer together.

In an example, the device can be changed from its first configuration toits second configuration by longitudinally pushing and/or sliding one ormore wires (or bands) along the tubular mesh. In an example, a tubularmesh can have outer and inner layers. In an example, a device can bechanged from its first configuration to its second configuration bylongitudinally pushing and/or sliding one or more wires (or bands) alonga space between those outer and inner layers. In an example, a devicecan have: a longitudinal series of circular circumferential wires (orbands) which do not move as the device changes from its firstconfiguration to its second configuration; and a longitudinal series ofundulating circumferential wires (or bands) which move as the devicechanges from its first configuration to its second configuration. Lackof movement of the former components (circular wires or bands) can helpto avoid twisting or pinching the vessel wall. Movement of the lattercomponents (undulating wires or bands) can help to close the gap throughwhich a catheter was extended.

In an example, wires (or bands) in a longitudinal series ofcircumferential wires (or bands) can be circular. In an example, wires(or bands) in a longitudinal series of circumferential wires (or bands)can be undulating, sinusoidal, and/or serpentine. In an example, somewires (or bands) in a longitudinal series of circumferential wires (orbands) can be circular and other wires (or bands) in the longitudinalseries of circumferential wires (or bands) can be undulating,sinusoidal, and/or serpentine. In an example, wires (or bands) in alongitudinal series of circumferential wires (or bands) can alternatebetween circular wires (or bands) and undulating (e.g. sinusoidal and/orserpentine) wires (or bands).

In an example, a tubular mesh can be cylindrical. In an example, atubular mesh can be a metal stent. In an example, a tubular mesh can bea polymer stent. In an example, a tubular mesh can be a cut, braided, or3D printed. In an example, a tubular mesh can be an expandable wireframe. In an example, a tubular mesh can self-expand when released froma catheter. In an example, a tubular mesh can further compriseradio-opaque sections or markers.

FIG. 9 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a tubular mesh 901 which isconfigured to be inserted into a parent blood vessel of an aneurysm; aplurality of longitudinal wires or bands (including wires or bands 902and 903) which longitudinally span the tubular mesh; a plurality ofproximal detachment locations (including 904) on the longitudinal wiresor bands; and a plurality of distal detachment locations (including 905)on the longitudinal wires or bands, wherein “distal” means closer to theend of the device which is first inserted into the person's body and“proximal” means farther from this end, wherein proximal detachmentlocations are severed on a selected second set of longitudinal wires orbands (including 903) along a side of the tubular mesh which are a firstdistance from the aneurysm neck, wherein distal detachment locations aresevered on a selected first set of longitudinal wires or bands(including 903) along a side of the tubular mesh which are a seconddistance from the aneurysm neck, wherein the second distance is greaterthan the first distance, and wherein the second set of longitudinalwires or bands is removed from the device.

The upper half of FIG. 9 shows this device at a first point in timebefore the second set of longitudinal wires or bands has been removed.The lower half of FIG. 9 shows this device at a second point in timeafter the second set of longitudinal wires or bands has been removed. Inan example, this selective detachment and removal of longitudinal wiresor bands results in a lower-porosity portion (e.g. on the side) of thedevice closer to the aneurysm neck and a higher-porosity portion (e.g.on the side) of the device farther from the aneurysm neck.

In a variation on this example, a device for occluding a cerebralaneurysm can comprise: a tubular mesh which is configured to be insertedinto a parent blood vessel of an aneurysm; a plurality of longitudinalwires or bands which longitudinally span the tubular mesh; and aplurality of attachment locations on the longitudinal wires or bands,wherein attachment locations are not severed on a first set oflongitudinal wires or bands along a side of the tubular mesh which are afirst distance from the aneurysm neck, wherein attachment locations aresevered on a second set of longitudinal wires or bands along a side ofthe tubular mesh which are a second distance from the aneurysm neck,wherein the second distance is greater than the first distance, andwherein the second set of longitudinal wires or bands is removed fromthe device. This selective detachment and removal of longitudinal wiresor bands results in a lower-porosity portion (e.g. on the side) of thedevice closer to the aneurysm neck and a higher-porosity portion (e.g.on the side) of the device farther from the aneurysm neck.

In an example, longitudinal wires or bands can be straight. In anexample, longitudinal wires or bands can be undulating, sinusoidal,and/or serpentine. In an example, longitudinal wires or bands cancollectively span the entire circumference of a tubular mesh before thesecond set of wires or bands is detached and removed. In an example,connection locations along longitudinal wires or bands can be severed bythe application of electromagnetic energy. In an example, the first setof longitudinal wires or bands can collectively span between 20% and 40%of the circumference or the tubular mesh. In an example, the first setof longitudinal wires or bands can collectively span a quarter of thecircumference or the tubular mesh. In an example, the first set oflongitudinal wires or bands can collectively span between 33% and 66% ofthe circumference or the tubular mesh. In an example, the first set oflongitudinal wires or bands can collectively span half of thecircumference or the tubular mesh.

FIG. 10 shows two sequential views of an example of a device foroccluding a cerebral aneurysm comprising: a catheter 1000 which isconfigured to be inserted into a parent blood vessel of an aneurysm; atubular mesh 1001 which is delivered to the parent vessel inside thecatheter; a plurality of longitudinal strips (including strips 1002,1003, 1004, and 1005) which are attached to the tubular mesh by aplurality of connections (including 1006, 1007, 1008, 1009, and 1010);wherein a subset of the connections (1008, 1009, and 1010) is severed bythe application of electromagnetic energy before the tubular meshextends out from the catheter; wherein a first set of the longitudinalstrips (1002) remains attached to the tubular mesh and extends out fromthe catheter as the tubular mesh extends out from the catheter; andwherein a second set of the longitudinal strips (1003, 1004, and 1005)is detached from the tubular mesh (by severing the subset of theconnections) and is not extended out from the catheter as the tubularmesh extends out from the catheter. The upper half of FIG. 10 shows thisdevice at a first point in time before the second set of longitudinalstrips has been detached and before the tubular mesh has been extendedout from the catheter. The lower half of FIG. 10 shows this device at asecond point in time after the second set of longitudinal strips hasbeen detached and after the tubular mesh has been extended out from thecatheter.

In an variation on this example, a device for occluding a cerebralaneurysm can comprise: a catheter which is configured to be insertedinto a parent blood vessel of an aneurysm; a tubular mesh which isdelivered to the parent vessel inside the catheter; a plurality oflongitudinal strips or bands within catheter; wherein a first subset ofthe longitudinal strips or bands which are a first distance from theaneurysm neck are attached (e.g. fused) to the tubular mesh by theapplication of electromagnetic after the catheter has been inserted intothe parent vessel but before the tubular mesh has been extended out ofthe catheter, and wherein a second subset of the longitudinal strips orbands which are a second distance from the aneurysm neck are notattached to the tubular mesh. This selective attachment of longitudinalstrips or bands results in a lower-porosity portion (e.g. on the side)of the device closer to the aneurysm neck and a higher-porosity portion(e.g. on the side) of the device farther from the aneurysm neck.

In an example, the longitudinal strips have a lower porosity than thetubular mesh. In an example, the longitudinal strips can be made from apolymer and the tubular mesh can be made from metal. In an example,longitudinal strips can be straight. In an example, longitudinal stripscan be undulating, sinusoidal, and/or serpentine. In an example,longitudinal strips can collectively span the entire circumference of atubular mesh before the second set of strips is detached and removed. Inan example, connection locations along longitudinal strips can besevered by the application of electromagnetic energy. In an example, thefirst set of longitudinal strips can collectively span between 20% and40% of the circumference or the tubular mesh. In an example, the firstset of longitudinal strips can collectively span a quarter of thecircumference or the tubular mesh. In an example, the first set oflongitudinal strips can collectively span between 33% and 66% of thecircumference or the tubular mesh. In an example, the first set oflongitudinal strips can collectively span half of the circumference orthe tubular mesh.

The left and right sides of FIG. 11 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a half-torus mesh 1102 which is configured to be radiallyexpanded within an aneurysm 1101 to bridge the neck of the aneurysm; acentral opening 1103 in the half-torus mesh; a valve 1104 in the centralopening; and embolic coils (or other embolic members) 1105 which areinserted through the valve into the aneurysm. The left side of FIG. 11shows this device at a first point in time before embolic coils havebeen inserted through the valve into the aneurysm. The right side ofFIG. 11 shows this device at a second point in time after embolic coilshave been inserted through the valve into the aneurysm. After theaneurysm sac has been occluded with embolic coils, any portion of thecoils which remains outside the aneurysm is detached and removed and thevalve is closed to reduce blood flow into the aneurysm.

In an example, a half-torus mesh can be the lower surface of the lowerhalf of a torus. This is analogous to the lower surface of a half of abagel lying flat on a surface. Following this analogy, the centralopening in the half-torus is analogous to the hole in a half bagel,although probably not as relatively large as the hole in a half bagel.In an example, the cross-sectional area of the central opening in thehalf-torus mesh can be between 5% to 15% of the maximum cross-sectionalarea of the half-torus mesh. In an example, the cross-sectional area ofthe central opening in the half-torus mesh can be between 10% to 30% ofthe maximum cross-sectional area of the half-torus mesh. In an example,a half-torus mesh can be created geometrically by rotating anupward-opening arc (e.g. a section of a circle or a parabola) around avertical axis (in space) which is to the right or left of the arc. In anexample, the central portion of a half-torus mesh can comprise anupward-rising cone, analogous to the cone of a volcano, with the openingbeing where the crater of a volcano would be. In an example, thehalf-torus mesh can radially expand within the aneurysm sac to a widthwhich is greater than the width of the aneurysm neck.

In an example, a half-torus mesh can have uniform porosity. In anexample, a half-torus mesh can have a uniform durometer level. In anexample, a half-torus mesh can have uniform elasticity. In an example,the outer perimeter of the half-torus mesh can have greater porositythan the central portion of the half-torus mesh. In an example, theouter perimeter of the half-torus mesh can have a greater durometerlevel than the central portion of the half-torus mesh. In an example,the outer perimeter of the half-torus mesh can be more elastic than thecentral portion of the half-torus mesh. In an example, the outerperimeter of the half-torus mesh can have lower porosity than thecentral portion of the half-torus mesh. In an example, the outerperimeter of the half-torus mesh can have a lower durometer level thanthe central portion of the half-torus mesh. In an example, the outerperimeter of the half-torus mesh can be less elastic than the centralportion of the half-torus mesh.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when an embolic coil is pushed through it andpassively close when the end of the coil passes or when a portion of thecoil is detached and removed. In an example, such a valve allows emboliccoils to be inserted into the aneurysm after the half-torus mesh hasbeen expanded in the aneurysm, but closes to reduce blood flow into theaneurysm after the end of the coil has passed through the valve. In analternative example, an active valve can be remotely opened and/orclosed by the operator of the device. In an example, an active valve canbe remotely opened and/or closed by an operator by the application ofelectromagnetic energy. In an example, an active valve can be remotelyopened and/or closed by an operator by pulling a filament. In anexample, an active valve can be remotely opened and/or closed by anoperator by pushing, pulling, or rotating a wire. In an example, anactive valve can be remotely opened and/or closed by an operator bycutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 12 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a toroidal mesh 1202 which is configured to be radiallyexpanded within an aneurysm 1201 to bridge the neck of the aneurysm; acentral opening 1203 in the toroidal mesh; a valve 1204 in the centralopening; and embolic coils (or other embolic members) 1205 which areinserted through the valve into the aneurysm. The left side of FIG. 12shows this device at a first point in time before embolic coils havebeen inserted through the valve into the aneurysm. The right side ofFIG. 12 shows this device at a second point in time after embolic coilshave been inserted through the valve into the aneurysm. After theaneurysm sac has been occluded with embolic coils, any portion of thecoils which remains outside the aneurysm is detached and removed and thevalve is closed to reduce blood flow into the aneurysm.

In an example, a toroidal mesh can be the outer surface of a torus. Thisis analogous to the outer surface of a bagel. Following this analogy,the central opening in the toroidal mesh is analogous to the hole in abagel, although probably not as relatively large as the hole in a bagel.In an example, the cross-sectional area of the central opening in thetoroidal mesh can be between 5% to 15% of the maximum cross-sectionalarea of the toroidal mesh. In an example, the cross-sectional area ofthe central opening in the toroidal mesh can be between 10% to 30% ofthe maximum cross-sectional area of the toroidal mesh. In an example, atoroidal mesh can be created geometrically by rotating a circle orellipse around a vertical axis (in space) which is to the right or leftof the circle or ellipse. In an example, the opening can have ahyperbolic cross-section. In an example, a toroidal mesh can radiallyexpand within the aneurysm sac to a width which is greater than thewidth of the aneurysm neck.

In an example, a toroidal mesh can have uniform porosity. In an example,a toroidal mesh can have a uniform durometer level. In an example, atoroidal mesh can have uniform elasticity. In an example, the outerperimeter of the toroidal mesh can have greater porosity than thecentral portion of the toroidal mesh. In an example, the outer perimeterof the toroidal mesh can have a greater durometer level than the centralportion of the toroidal mesh. In an example, the outer perimeter of thetoroidal mesh can be more elastic than the central portion of thetoroidal mesh. In an example, the outer perimeter of the toroidal meshcan have lower porosity than the central portion of the toroidal mesh.In an example, the outer perimeter of the toroidal mesh can have a lowerdurometer level than the central portion of the toroidal mesh. In anexample, the outer perimeter of the toroidal mesh can be less elasticthan the central portion of the toroidal mesh.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when an embolic coil is pushed through it andpassively close when the end of the coil passes or when a portion of thecoil is detached and removed. In an example, such a valve allows emboliccoils to be inserted into the aneurysm after the toroidal mesh has beenexpanded in the aneurysm, but closes to reduce blood flow into theaneurysm after the end of the coil has passed through the valve. In analternative example, an active valve can be remotely opened and/orclosed by the operator of the device. In an example, an active valve canbe remotely opened and/or closed by an operator by the application ofelectromagnetic energy. In an example, an active valve can be remotelyopened and/or closed by an operator by pulling a filament. In anexample, an active valve can be remotely opened and/or closed by anoperator by pushing, pulling, or rotating a wire. In an example, anactive valve can be remotely opened and/or closed by an operator bycutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 13 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a bowl-shaped mesh 1302 which is configured to be radiallyexpanded within an aneurysm 1301 to bridge the neck of the aneurysm; acentral opening 1303 in the bowl-shaped mesh; a valve 1304 in thecentral opening; and embolic coils (or other embolic members) 1305 whichare inserted through the valve into the aneurysm. The left side of FIG.13 shows this device at a first point in time before embolic coils havebeen inserted through the valve into the aneurysm. The right side ofFIG. 13 shows this device at a second point in time after embolic coilshave been inserted through the valve into the aneurysm. After theaneurysm sac has been occluded with embolic coils, any portion of thecoils which remains outside the aneurysm is detached and removed and thevalve is closed to reduce blood flow into the aneurysm.

In an example, a bowl-shaped mesh can be a section of a sphere orellipsoid. In an example, a bowl-shaped mesh can be hemispherical. In anexample, the cross-sectional area of the central opening in thebowl-shaped mesh can be between 5% to 15% of the maximum cross-sectionalarea of the bowl-shaped mesh. In an example, the cross-sectional area ofthe central opening in the bowl-shaped mesh can be between 10% to 30% ofthe maximum cross-sectional area of the bowl-shaped mesh. In an example,a bowl-shaped mesh can be created geometrically by rotating an arc of acircle or ellipse around a vertical axis (in space) which is to theright or left of the circle or ellipse. In an example, a bowl-shapedmesh can radially expand within the aneurysm sac to a width which isgreater than the width of the aneurysm neck.

In an example, a bowl-shaped mesh can have uniform porosity. In anexample, a bowl-shaped mesh can have a uniform durometer level. In anexample, a bowl-shaped mesh can have uniform elasticity. In an example,the outer perimeter of the bowl-shaped mesh can have greater porositythan the central portion of the bowl-shaped mesh. In an example, theouter perimeter of the bowl-shaped mesh can have a greater durometerlevel than the central portion of the bowl-shaped mesh. In an example,the outer perimeter of the bowl-shaped mesh can be more elastic than thecentral portion of the bowl-shaped mesh. In an example, the outerperimeter of the bowl-shaped mesh can have lower porosity than thecentral portion of the bowl-shaped mesh. In an example, the outerperimeter of the bowl-shaped mesh can have a lower durometer level thanthe central portion of the bowl-shaped mesh. In an example, the outerperimeter of the bowl-shaped mesh can be less elastic than the centralportion of the bowl-shaped mesh.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when an embolic coil is pushed through it andpassively close when the end of the coil passes or when a portion of thecoil is detached and removed. In an example, such a valve allows emboliccoils to be inserted into the aneurysm after the bowl-shaped mesh hasbeen expanded in the aneurysm, but closes to reduce blood flow into theaneurysm after the end of the coil has passed through the valve. In analternative example, an active valve can be remotely opened and/orclosed by the operator of the device. In an example, an active valve canbe remotely opened and/or closed by an operator by the application ofelectromagnetic energy. In an example, an active valve can be remotelyopened and/or closed by an operator by pulling a filament. In anexample, an active valve can be remotely opened and/or closed by anoperator by pushing, pulling, or rotating a wire. In an example, anactive valve can be remotely opened and/or closed by an operator bycutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 14 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a distal flexible net 1405 which is inserted into ananeurysm 1401; a proximal half-torus mesh 1402 which is configured to beradially expanded within the aneurysm to bridge the neck of theaneurysm; a central opening 1403 in the half-torus mesh; a valve 1404 inthe central opening; and a string-of-pearls embolic member (e.g. alongitudinal series of embolic components which are connected by aflexible filament or wire) 1407 which is delivered through a catheter1406 and inserted through the valve into the distal flexible net,thereby expanding the distal flexible net to fill the sac of even anirregularly-shaped aneurysm.

The left side of FIG. 14 shows this device at a first point in timebefore the string-of-pearls embolic member has been inserted through thevalve into the distal flexible net. The right side of FIG. 14 shows thisdevice at a second point in time after the string-of-pearls embolicmember has been inserted through the valve into the distal flexible net.In an example, the distal flexible net can be attached to the half-torusmesh. In an example, the distal flexible net can be attached to thedistal surface of the half-torus mesh. In an example, the distalflexible net can be attached to the outer perimeter of the half-torusmesh. In an example, the distal flexible net can be separate from thehalf-torus mesh. In an example, the distal flexible mesh can be madefrom a polymer and the half-torus mesh can be made from metal.

In an example, a string-of-pearls embolic member can comprise alongitudinal series of embolic components (e.g. the “pearls”) which areconnected by a flexible filament or wire (e.g. the “string”). In anexample, the pearl components in a string-of-pearls embolic member canhave an average size which is greater than the average size of openingsin the distal flexible net. In an example, the pearl components in astring-of-pearls embolic member can have an average size which isbetween 1 and 5 times the average size of openings in the distalflexible net. In an example, the average length of filament or wiresegments connecting pearl components in a string-of-pearls embolicmember can be between 1 and 10 times the average size of the pearlcomponents in the string-of-pearls embolic member. In an example, theaverage length of filament or wire segments connecting pearl componentsin a string-of-pearls embolic member can be between 1 and 10 times theaverage size of openings in the distal flexible net. In an example,series of separate embolic members (e.g. microsponges or hydrogels) canbe inserted instead of a string-of-pearls embolic member.

In an example, a half-torus mesh can be the lower surface of the lowerhalf of a torus. This is analogous to the lower surface of a half of abagel lying flat on a surface. Following this analogy, the centralopening in the half-torus is analogous to the hole in a half bagel,although probably not as relatively large as the hole in a half bagel.In an example, the cross-sectional area of the central opening in thehalf-torus mesh can be between 5% to 15% of the maximum cross-sectionalarea of the half-torus mesh. In an example, the cross-sectional area ofthe central opening in the half-torus mesh can be between 10% to 30% ofthe maximum cross-sectional area of the half-torus mesh. In an example,a half-torus mesh can be created geometrically by rotating anupward-opening arc (e.g. a section of a circle or a parabola) around avertical axis (in space) which is to the right or left of the arc. In anexample, the central portion of a half-torus mesh can comprise anupward-rising cone, analogous to the cone of a volcano, with the openingbeing where the crater of a volcano would be. In an example, thehalf-torus mesh can radially expand within the aneurysm sac to a widthwhich is greater than the width of the aneurysm neck.

In an example, a half-torus mesh can have uniform porosity. In anexample, a half-torus mesh can have a uniform durometer level. In anexample, a half-torus mesh can have uniform elasticity. In an example,the outer perimeter of the half-torus mesh can have greater porositythan the central portion of the half-torus mesh. In an example, theouter perimeter of the half-torus mesh can have a greater durometerlevel than the central portion of the half-torus mesh. In an example,the outer perimeter of the half-torus mesh can be more elastic than thecentral portion of the half-torus mesh. In an example, the outerperimeter of the half-torus mesh can have lower porosity than thecentral portion of the half-torus mesh. In an example, the outerperimeter of the half-torus mesh can have a lower durometer level thanthe central portion of the half-torus mesh. In an example, the outerperimeter of the half-torus mesh can be less elastic than the centralportion of the half-torus mesh.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when a string-of-pearls embolic member is pushedthrough it and passively close when the end of the embolic member passesor when a portion of the embolic member is detached and removed. In anexample, such a valve allows a string-of-pearls embolic member to beinserted into the distal flexible net after the half-torus mesh has beenexpanded in the aneurysm, but closes to reduce blood flow into theaneurysm after the end of the embolic member has passed through thevalve. In an alternative example, an active valve can be remotely openedand/or closed by the operator of the device. In an example, an activevalve can be remotely opened and/or closed by an operator by theapplication of electromagnetic energy. In an example, an active valvecan be remotely opened and/or closed by an operator by pulling afilament. In an example, an active valve can be remotely opened and/orclosed by an operator by pushing, pulling, or rotating a wire. In anexample, an active valve can be remotely opened and/or closed by anoperator by cutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 15 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a distal flexible net 1505 which is inserted into ananeurysm 1501; a proximal toroidal mesh 1502 which is configured to beradially expanded within the aneurysm to bridge the neck of theaneurysm; a central opening 1503 in the toroidal mesh; a valve 1504 inthe central opening; and a string-of-pearls embolic member (e.g. alongitudinal series of embolic components which are connected by aflexible filament or wire) 1507 which is delivered through a catheter1506 and inserted through the valve into the distal flexible net,thereby expanding the distal flexible net to fill the sac of even anirregularly-shaped aneurysm.

The left side of FIG. 15 shows this device at a first point in timebefore the string-of-pearls embolic member has been inserted through thevalve into the distal flexible net. The right side of FIG. 15 shows thisdevice at a second point in time after the string-of-pearls embolicmember has been inserted through the valve into the distal flexible net.In an example, the distal flexible net can be attached to the toroidalmesh. In an example, the distal flexible net can be attached to thedistal surface of the toroidal mesh. In an example, the distal flexiblenet can be attached to the outer perimeter of the toroidal mesh. In anexample, the distal flexible net can be separate from the toroidal mesh.In an example, the distal flexible mesh can be made from a polymer andthe toroidal mesh can be made from metal.

In an example, a string-of-pearls embolic member can comprise alongitudinal series of embolic components (e.g. the “pearls”) which areconnected by a flexible filament or wire (e.g. the “string”). In anexample, the pearl components in a string-of-pearls embolic member canhave an average size which is greater than the average size of openingsin the distal flexible net. In an example, the pearl components in astring-of-pearls embolic member can have an average size which isbetween 1 and 5 times the average size of openings in the distalflexible net. In an example, the average length of filament or wiresegments connecting pearl components in a string-of-pearls embolicmember can be between 1 and 10 times the average size of the pearlcomponents in the string-of-pearls embolic member. In an example, theaverage length of filament or wire segments connecting pearl componentsin a string-of-pearls embolic member can be between 1 and 10 times theaverage size of openings in the distal flexible net. In an example,series of separate embolic members (e.g. microsponges or hydrogels) canbe inserted instead of a string-of-pearls embolic member.

In an example, a toroidal mesh can be the outer surface of a torus. Thisis analogous to the outer surface of a bagel. Following this analogy,the central opening in the toroidal mesh is analogous to the hole in abagel, although probably not as relatively large as the hole in a bagel.In an example, the cross-sectional area of the central opening in thetoroidal mesh can be between 5% to 15% of the maximum cross-sectionalarea of the toroidal mesh. In an example, the cross-sectional area ofthe central opening in the toroidal mesh can be between 10% to 30% ofthe maximum cross-sectional area of the toroidal mesh. In an example, atoroidal mesh can be created geometrically by rotating a circle orellipse around a vertical axis (in space) which is to the right or leftof the circle or ellipse. In an example, the opening can have ahyperbolic cross-section. In an example, a toroidal mesh can radiallyexpand within the aneurysm sac to a width which is greater than thewidth of the aneurysm neck.

In an example, a toroidal mesh can have uniform porosity. In an example,a toroidal mesh can have a uniform durometer level. In an example, atoroidal mesh can have uniform elasticity. In an example, the outerperimeter of the toroidal mesh can have greater porosity than thecentral portion of the toroidal mesh. In an example, the outer perimeterof the toroidal mesh can have a greater durometer level than the centralportion of the toroidal mesh. In an example, the outer perimeter of thetoroidal mesh can be more elastic than the central portion of thetoroidal mesh. In an example, the outer perimeter of the toroidal meshcan have lower porosity than the central portion of the toroidal mesh.In an example, the outer perimeter of the toroidal mesh can have a lowerdurometer level than the central portion of the toroidal mesh. In anexample, the outer perimeter of the toroidal mesh can be less elasticthan the central portion of the toroidal mesh.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when a string-of-pearls embolic member is pushedthrough it and passively close when the end of the embolic member passesor when a portion of the embolic member is detached and removed. In anexample, such a valve allows a string-of-pearls embolic member to beinserted into the distal flexible net after the toroidal mesh has beenexpanded in the aneurysm, but closes to reduce blood flow into theaneurysm after the end of the embolic member has passed through thevalve. In an alternative example, an active valve can be remotely openedand/or closed by the operator of the device. In an example, an activevalve can be remotely opened and/or closed by an operator by theapplication of electromagnetic energy. In an example, an active valvecan be remotely opened and/or closed by an operator by pulling afilament. In an example, an active valve can be remotely opened and/orclosed by an operator by pushing, pulling, or rotating a wire. In anexample, an active valve can be remotely opened and/or closed by anoperator by cutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 16 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a distal flexible net 1605 which is inserted into ananeurysm 1601; a proximal bowl-shaped mesh 1602 which is configured tobe radially expanded within the aneurysm to bridge the neck of theaneurysm; a central opening 1603 in the bowl-shaped mesh; a valve 1604in the central opening; and a string-of-pearls embolic member (e.g. alongitudinal series of embolic components which are connected by aflexible filament or wire) 1607 which is delivered through a catheter1606 and inserted through the valve into the distal flexible net,thereby expanding the distal flexible net to fill the sac of even anirregularly-shaped aneurysm.

The left side of FIG. 16 shows this device at a first point in timebefore the string-of-pearls embolic member has been inserted through thevalve into the distal flexible net. The right side of FIG. 16 shows thisdevice at a second point in time after the string-of-pearls embolicmember has been inserted through the valve into the distal flexible net.In an example, the distal flexible net can be attached to thebowl-shaped mesh. In an example, the distal flexible net can be attachedto the distal surface of the bowl-shaped mesh. In an example, the distalflexible net can be attached to the outer perimeter of the bowl-shapedmesh. In an example, the distal flexible net can be separate from thebowl-shaped mesh. In an example, the distal flexible mesh can be madefrom a polymer and the bowl-shaped mesh can be made from metal.

In an example, a string-of-pearls embolic member can comprise alongitudinal series of embolic components (e.g. the “pearls”) which areconnected by a flexible filament or wire (e.g. the “string”). In anexample, the pearl components in a string-of-pearls embolic member canhave an average size which is greater than the average size of openingsin the distal flexible net. In an example, the pearl components in astring-of-pearls embolic member can have an average size which isbetween 1 and 5 times the average size of openings in the distalflexible net. In an example, the average length of filament or wiresegments connecting pearl components in a string-of-pearls embolicmember can be between 1 and 10 times the average size of the pearlcomponents in the string-of-pearls embolic member. In an example, theaverage length of filament or wire segments connecting pearl componentsin a string-of-pearls embolic member can be between 1 and 10 times theaverage size of openings in the distal flexible net. In an example,series of separate embolic members (e.g. microsponges or hydrogels) canbe inserted instead of a string-of-pearls embolic member.

In an example, a bowl-shaped mesh can be a section of a sphere orellipsoid. In an example, a bowl-shaped mesh can be hemispherical. In anexample, the cross-sectional area of the central opening in thebowl-shaped mesh can be between 5% to 15% of the maximum cross-sectionalarea of the bowl-shaped mesh. In an example, the cross-sectional area ofthe central opening in the bowl-shaped mesh can be between 10% to 30% ofthe maximum cross-sectional area of the bowl-shaped mesh. In an example,a bowl-shaped mesh can be created geometrically by rotating a circle orellipse around a vertical axis (in space) which is to the right or leftof the circle or ellipse. In an example, a bowl-shaped mesh can radiallyexpand within the aneurysm sac to a width which is greater than thewidth of the aneurysm neck.

In an example, a bowl-shaped mesh can have uniform porosity. In anexample, a bowl-shaped mesh can have a uniform durometer level. In anexample, a bowl-shaped mesh can have uniform elasticity. In an example,the outer perimeter of the bowl-shaped mesh can have greater porositythan the central portion of the bowl-shaped mesh. In an example, theouter perimeter of the bowl-shaped mesh can have a greater durometerlevel than the central portion of the bowl-shaped mesh. In an example,the outer perimeter of the bowl-shaped mesh can be more elastic than thecentral portion of the bowl-shaped mesh. In an example, the outerperimeter of the bowl-shaped mesh can have lower porosity than thecentral portion of the bowl-shaped mesh. In an example, the outerperimeter of the bowl-shaped mesh can have a lower durometer level thanthe central portion of the bowl-shaped mesh. In an example, the outerperimeter of the bowl-shaped mesh can be less elastic than the centralportion of the bowl-shaped mesh.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when a string-of-pearls embolic member is pushedthrough it and passively close when the end of the embolic member passesor when a portion of the embolic member is detached and removed. In anexample, such a valve allows a string-of-pearls embolic member to beinserted into the distal flexible net after the bowl-shaped mesh hasbeen expanded in the aneurysm, but closes to reduce blood flow into theaneurysm after the end of the embolic member has passed through thevalve. In an alternative example, an active valve can be remotely openedand/or closed by the operator of the device. In an example, an activevalve can be remotely opened and/or closed by an operator by theapplication of electromagnetic energy. In an example, an active valvecan be remotely opened and/or closed by an operator by pulling afilament. In an example, an active valve can be remotely opened and/orclosed by an operator by pushing, pulling, or rotating a wire. In anexample, an active valve can be remotely opened and/or closed by anoperator by cutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 17 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a flexible net or mesh which is inserted into an aneurysm1701; wherein the flexible net further comprises a proximal portion1702, wherein the proximal portion is configured to be a first distancefrom the aneurysm neck and has a first level of flexibility (orelasticity); wherein the flexible net further comprises a distal portion1703, wherein the distal portion is configured to be a second distancefrom the aneurysm neck and has a second level of flexibility (orelasticity), wherein the second distance is greater than the firstdistance, and wherein the second level is greater than the first level;a central opening 1705 in the proximal portion; a valve 1706 in thecentral opening; and a string-of-pearls embolic member (e.g. alongitudinal series of embolic components which are connected by aflexible filament or wire) 1708 which is delivered through a catheter1707 and inserted through the valve into the flexible net or mesh,thereby expanding the flexible net or mesh to fill the sac of even anirregularly-shaped aneurysm. The left side of FIG. 17 shows this deviceat a first point in time before the string-of-pearls embolic member hasbeen inserted through the valve into the flexible net. The right side ofFIG. 17 shows this device at a second point in time after thestring-of-pearls embolic member has been inserted through the valve intothe flexible net.

In an example, a proximal portion of a flexible net (or mesh) can bemade from one or more metals and a distal portion of the flexible net(or mesh) can be made from one or more polymers. In an example, thecomposition of a proximal portion can have a greater percentage of metalthan that of a distal portion. In an example, filaments, tubes, fibers,or wires in a proximal portion can be closer together than those in adistal portion. In an example, the proximal portion can have a firstporosity level and the distal portion can have a second porosity level,wherein the second level is greater than the first level. In an example,the outer perimeter of the proximal portion can have a lower porositythan the central area of the proximal portion (apart from the centralopening). In an example, the outer perimeter of the proximal portion canhave a lower durometer level than the central area of the proximalportion. In an example, the outer perimeter of the proximal portion canbe less elastic than the central area of the proximal portion.

In an example, a proximal portion of a flexible net (or mesh) can have afirst resilience (or strength) level and the distal portion of theflexible net (or mesh) can have a second resilience (or strength) level,wherein the second level is less than the first level. In an example,the proximal portion can have a first elastic modulus and the distalportion can have a second elastic modulus, wherein the second elasticmodulus is greater than the first elastic modulus. In an example, theproximal portion can have a first Shore durometer and the distal portioncan have a second Shore durometer, wherein the second Shore durometer isless than the first Shore durometer. In an example, a proximal portionof a flexible net can have more layers than a distal portion of theflexible net. In an example, a proximal portion of a flexible net cancomprise a single layer and a distal portion of the flexible net cancomprise two or more layers.

In an example, a proximal portion of a flexible net (or mesh) cancomprise between 20% and 40% area of the flexible net (or mesh) and adistal portion can comprise the remainder of the area of the flexiblenet (or mesh). In an example, the proximal portion can comprise onethird of the area of the flexible net (or mesh) and the distal portioncan comprise two thirds of the area of the flexible net (or mesh). In anexample, the proximal portion can comprise between 33% and 66% of thearea of the flexible net (or mesh) and the distal portion can comprisethe remainder of the area of the flexible net (or mesh). In an example,the proximal portion can comprise one half of the area of the flexiblenet (or mesh) and the distal portion can comprise the other half of thearea of the flexible net (or mesh).

In an example, a string-of-pearls embolic member can comprise alongitudinal series of embolic components (e.g. the “pearls”) which areconnected by a flexible filament or wire (e.g. the “string”). In anexample, the pearl components in a string-of-pearls embolic member canhave an average size which is greater than the average size of openingsin the distal portion of the flexible net (or mesh). In an example, thepearl components in a string-of-pearls embolic member can have anaverage size which is between 1 and 5 times the average size of openingsin the distal portion. In an example, the average length of filament orwire segments connecting pearl components in a string-of-pearls embolicmember can be between 1 and 10 times the average size of the pearlcomponents in the string-of-pearls embolic member. In an example, theaverage length of filament or wire segments connecting pearl componentsin a string-of-pearls embolic member can be between 1 and 10 times theaverage size of openings in the distal portion. In an example, series ofseparate embolic members (e.g. microsponges or hydrogels) can beinserted instead of a string-of-pearls embolic member.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when a string-of-pearls embolic member is pushedthrough it and passively close when the end of the embolic member passesor when a portion of the embolic member is detached and removed. In anexample, such a valve allows a string-of-pearls embolic member to beinserted into the distal portion after the distal portion has beenexpanded in the aneurysm, but closes to reduce blood flow into theaneurysm after the end of the embolic member has passed through thevalve. In an alternative example, an active valve can be remotely openedand/or closed by the operator of the device. In an example, an activevalve can be remotely opened and/or closed by an operator by theapplication of electromagnetic energy. In an example, an active valvecan be remotely opened and/or closed by an operator by pulling afilament. In an example, an active valve can be remotely opened and/orclosed by an operator by pushing, pulling, or rotating a wire. In anexample, an active valve can be remotely opened and/or closed by anoperator by cutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 18 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a flexible net 1803 which is inserted into an aneurysm 1801;a resilient mesh (e.g. a stent) 1802 which encircles a centralcircumference of the flexible net; a proximal opening 1805 in theflexible net; a valve 1806 in the proximal opening; and astring-of-pearls embolic member (e.g. a longitudinal series of emboliccomponents which are connected by a flexible filament or wire) 1808which is delivered through a catheter 1807 and inserted through thevalve into the flexible net, thereby expanding the flexible net or meshto fill the sac of even an irregularly-shaped aneurysm. The left side ofFIG. 18 shows this device at a first point in time before thestring-of-pearls embolic member has been inserted through the valve intothe flexible net. The right side of FIG. 18 shows this device at asecond point in time after the string-of-pearls embolic member has beeninserted through the valve into the flexible net.

In an example, a resilient mesh can be a metal stent or a polymer stent.In an example, a resilient mesh can be made from one or more metals anda flexible mesh can be made from one or more polymers.

In an example, a resilient mesh can be an expandable wire frame. In anexample, a resilient mesh can self-expand in a radial manner within theaneurysm sac. In an example, a resilient mesh can be a circular stent.

In an example, a resilient mesh can be an ellipsoidal stent. In anexample, a resilient mesh can be a cylindrical stent. In an example, aresilient mesh can be a tubular stent. In an example, a resilient meshcan be a toroidal stent. In an example, a resilient mesh can be cut,braided, or 3D printed. In an example, a resilient mesh can furthercomprise radio-opaque sections or markers.

In an example, a resilient mesh can span a central and/or maximaldiameter of an aneurysm sac. In an example, a resilient mesh can span acentral and/or maximal circumference of an aneurysm sac. In an example,a resilient mesh can be attached to the interior surface of a flexiblenet. In an example, a resilient mesh can be attached to the exteriorsurface of a flexible net. In an example, a resilient mesh can overlapbetween 5% and 15% of the area of a flexible net when both are expandedwithin an aneurysm sac. In an example, a resilient mesh can overlapbetween 10% and 30% of the area of a flexible net when both are expandedwithin an aneurysm sac.

In an example, a string-of-pearls embolic member can comprise alongitudinal series of embolic components (e.g. the “pearls”) which areconnected by a flexible filament or wire (e.g. the “string”). In anexample, a flexible net can have quadrilateral-shaped openings. In anexample, a flexible net can have hexagonal openings. In an example, aflexible net can have triangular openings. In an example, a flexible netcan have circular openings. In an example, embolic components (e.g. the“pearls”) in a string-of-pearls embolic member can be generallyspherical and openings in a flexible net can be generally circular. Inan example, embolic components (e.g. the “pearls”) in a string-of-pearlsembolic member can be generally polygonal and openings in a flexible netcan be generally circular. In an example, embolic components (e.g. the“pearls”) in a string-of-pearls embolic member can be generallyspherical and openings in a flexible net can be generally polygonal.

In an example, pearl components in a string-of-pearls embolic member canhave an average size which is greater than the average size of openingsin a flexible net. In an example, pearl components in a string-of-pearlsembolic member can have an average size which is between 1 and 5 timesthe average size of openings in the flexible net. In an example, theaverage length of filament or wire segments connecting pearl componentsin a string-of-pearls embolic member can be between 1 and 10 times theaverage size of the pearl components in the string-of-pearls embolicmember. In an example, the average length of filament or wire segmentsconnecting pearl components in a string-of-pearls embolic member can bebetween 1 and 10 times the average size of openings in the flexible net.In an example, series of separate embolic members (e.g. microsponges orhydrogels) can be inserted instead of a string-of-pearls embolic member.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when a string-of-pearls embolic member is pushedthrough it and passively close when the end of the embolic member passesor when a portion of the embolic member is detached and removed. In anexample, such a valve allows a string-of-pearls embolic member to beinserted into the flexible net, but closes to reduce blood flow into theaneurysm after the end of the embolic member has passed through thevalve. In an alternative example, an active valve can be remotely openedand/or closed by the operator of the device. In an example, an activevalve can be remotely opened and/or closed by an operator by theapplication of electromagnetic energy. In an example, an active valvecan be remotely opened and/or closed by an operator by pulling afilament. In an example, an active valve can be remotely opened and/orclosed by an operator by pushing, pulling, or rotating a wire. In anexample, an active valve can be remotely opened and/or closed by anoperator by cutting, pulling, or pushing a flap or plug.

The left and right sides of FIG. 19 show two sequential views of anexample of an intrasacular device for occluding a cerebral aneurysmcomprising: a flexible net 1902 which is inserted into an aneurysm 1901;a disk or ball-shaped mesh 1903 inside the flexible net; a proximalopening 1905 in the flexible net; a valve 1906 in the proximal opening;and a string-of-pearls embolic member (e.g. a longitudinal series ofembolic components which are connected by a flexible filament or wire)1908 which is delivered through a catheter 1907 and inserted through thevalve into the flexible net, thereby expanding the flexible net or meshto fill the sac of even an irregularly-shaped aneurysm. The left side ofFIG. 19 shows this device at a first point in time before thestring-of-pearls embolic member has been inserted through the valve intothe flexible net. The right side of FIG. 19 shows this device at asecond point in time after the string-of-pearls embolic member has beeninserted through the valve into the flexible net.

In an example, a disk or ball-shaped mesh can spherical. In an example,a disk or ball-shaped mesh can ellipsoidal. In an example, a disk orball-shaped mesh can apple or barrel shaped. In an example, a disk orball-shaped mesh can be made from one or more metals and a flexible meshcan be made from one or more polymers. In an example, a disk orball-shaped mesh can be an expandable wire frame. In an example, a diskor ball-shaped mesh can self-expand in a radial manner within theaneurysm sac. In an example, a disk or ball-shaped mesh can be cut,braided, or 3D printed. In an example, a disk or ball-shaped mesh canfurther comprise radio-opaque sections or markers. In an example, therecan be an opening in the disk or ball-shaped mesh in addition to theopening in the flexible net.

In an example, a string-of-pearls embolic member can comprise alongitudinal series of embolic components (e.g. the “pearls”) which areconnected by a flexible filament or wire (e.g. the “string”). In anexample, a flexible net can have quadrilateral-shaped openings. In anexample, a flexible net can have hexagonal openings. In an example, aflexible net can have triangular openings. In an example, a flexible netcan have circular openings. In an example, embolic components (e.g. the“pearls”) in a string-of-pearls embolic member can be generallyspherical and openings in a flexible net can be generally circular. Inan example, embolic components (e.g. the “pearls”) in a string-of-pearlsembolic member can be generally polygonal and openings in a flexible netcan be generally circular. In an example, embolic components (e.g. the“pearls”) in a string-of-pearls embolic member can be generallyspherical and openings in a flexible net can be generally polygonal.

In an example, pearl components in a string-of-pearls embolic member canhave an average size which is greater than the average size of openingsin a flexible net. In an example, pearl components in a string-of-pearlsembolic member can have an average size which is between 1 and 5 timesthe average size of openings in the flexible net. In an example, theaverage length of filament or wire segments connecting pearl componentsin a string-of-pearls embolic member can be between 1 and 10 times theaverage size of the pearl components in the string-of-pearls embolicmember. In an example, the average length of filament or wire segmentsconnecting pearl components in a string-of-pearls embolic member can bebetween 1 and 10 times the average size of openings in the flexible net.In an example, series of separate embolic members (e.g. microsponges orhydrogels) can be inserted instead of a string-of-pearls embolic member.

In an example, a valve in a central opening can be a leaflet valve. Inan example, a valve in a central opening can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve. In an example, a valvecan passively open when a string-of-pearls embolic member is pushedthrough it and passively close when the end of the embolic member passesor when a portion of the embolic member is detached and removed. In anexample, such a valve allows a string-of-pearls embolic member to beinserted into the flexible net, but closes to reduce blood flow into theaneurysm after the end of the embolic member has passed through thevalve. In an alternative example, an active valve can be remotely openedand/or closed by the operator of the device. In an example, an activevalve can be remotely opened and/or closed by an operator by theapplication of electromagnetic energy. In an example, an active valvecan be remotely opened and/or closed by an operator by pulling afilament. In an example, an active valve can be remotely opened and/orclosed by an operator by pushing, pulling, or rotating a wire. In anexample, an active valve can be remotely opened and/or closed by anoperator by cutting, pulling, or pushing a flap or plug. FIG. 20 showsfour sequential views of an example of an intrasacular device foroccluding a cerebral aneurysm comprising: a mesh (or framework) 2002which is configured to be inserted, radially-expanded, and thenlongitudinally-collapsed within an aneurysm 2001 in order to bridge theaneurysm neck, wherein the mesh (or framework) has a longitudinal firstconfiguration in which it is delivered through a catheter and insertedinto an aneurysm, wherein the mesh (or framework) has a single-layerglobular second configuration after it has been radially-expanded withinthe aneurysm, and wherein the mesh (or framework) has a double-layerbowl-shaped third configuration which bridges the aneurysm neck afterdistal and proximal portions of the mesh (or framework) have beenlongitudinally collapsed toward each other; one or more central openings(2003 and 2004) in the mesh (or framework); and embolic coils (or otherembolic members) 2006 which are delivered via a catheter 2005 andinserted through the one or more openings into the aneurysm.

The upper left quadrant of FIG. 20 shows this device at a first point intime wherein the mesh (or framework) has a longitudinal firstconfiguration and is being delivered from a catheter into an aneurysm.

The upper right quadrant of FIG. 20 shows this device at a second pointin time wherein the mesh (or framework) has a single-layer globularsecond configuration after it has been radially-expanded within theaneurysm. The lower left quadrant of FIG. 20 shows this device at athird point in time wherein the mesh (or framework) has a double-layerbowl-shaped third configuration which bridges the aneurysm neck afterdistal and proximal areas of the mesh (or framework) have beenlongitudinally collapsed toward each other. The lower right quadrant ofFIG. 20 shows this device at a fourth point in time wherein emboliccoils have been inserted into the aneurysm sac through one or moreopenings in the mesh (or framework) in its bowl-shaped configuration.

In an example, a mesh (or framework) in its bowl-shaped configurationcan be a section of a sphere or ellipsoid. In an example, a mesh in itsbowl-shaped configuration can be hemispherical. In an example, anopening can be between 5% to 15% of the maximum cross-sectional area ofa mesh in its bowl-shaped configuration. In an example, an opening canbe between 10% to 30% of the maximum cross-sectional area of a mesh inits bowl-shaped configuration. In an example, a mesh in its bowl-shapedconfiguration can be represented geometrically by rotating an ar of acircle or ellipse around a vertical axis (in space) which is to theright or left of the circle or ellipse. In an example, a mesh in itsbowl-shaped configuration can radially expand within the aneurysm sac toa width which is greater than the width of the aneurysm neck.

In an example, a mesh can have a single layer when it is in its firstand second configurations, but have a double layer when it is in itsthird configuration. In an example, a mesh can have more layers in itsthird configuration than in its first and second configurations. In anexample, a string-of-pearls embolic member or a plurality of separateembolic members (e.g. microsponges or hydrogels) can be inserted intothe aneurysm instead of embolic coils.

In an example, a mesh (or framework) in its bowl-shaped configurationcan have uniform porosity. In an example, a mesh in its bowl-shapedconfiguration can have a uniform durometer level. In an example, a meshin its bowl-shaped configuration can have uniform elasticity. In anexample, the outer perimeter of a mesh in its bowl-shaped configurationcan have greater porosity than the central portion of the mesh in itsbowl-shaped configuration. In an example, the outer perimeter of a meshin its bowl-shaped configuration can have a greater durometer level thanthe central portion of the mesh in its bowl-shaped configuration. In anexample, the outer perimeter of a mesh in its bowl-shaped configurationcan be more elastic than the central portion of the mesh in itsbowl-shaped configuration. In an example, the outer perimeter of a meshin its bowl-shaped configuration can have lower porosity than thecentral portion of the mesh in its bowl-shaped configuration. In anexample, the outer perimeter of a mesh in its bowl-shaped configurationcan have a lower durometer level than the central portion of the mesh inits bowl-shaped configuration. In an example, the outer perimeter of amesh in its bowl-shaped configuration can be less elastic than thecentral portion of the mesh in its bowl-shaped configuration.

In an example, a mesh (or framework) can self-expand into its globularsecond configuration. In an example, a mesh can belongitudinally-compressed into its bowl-shaped third configuration bymovement of a wire, thread, and/or filament. In an example, a mesh canbe longitudinally-compressed into its bowl-shaped third configurationwhen a device operator pulls on a wire, thread, and/or filament. In anexample, a mesh can be longitudinally-compressed into its bowl-shapedthird configuration by the application of electromagnetic energy. In anexample, a mesh can be longitudinally-compressed into its bowl-shapedthird configuration when a device operator delivers electromagneticenergy to the mesh. In an example, a mesh can belongitudinally-compressed into its bowl-shaped third configuration bymovement of a catheter. In an example, a mesh can belongitudinally-compressed into its bowl-shaped third configuration by ahydraulic or pneumatic actuator. In an example, a mesh can belongitudinally-compressed into its bowl-shaped third configuration byone or more microscale actuators (e.g. MEMS).

FIG. 21 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a half-torus mesh 2101 which is configured to beradially-expanded within an aneurysm to bridge the aneurysm neck; avalve 2102 in the half-torus mesh; and a catheter 2103 through whichembolic members (e.g. coils, hydrogels, microsponges, beads, orstring-of-pearls strands) are inserted through the valve into theaneurysm. After the embolic members have been inserted, the valve isclosed and the catheter is removed.

In an example, a half-torus mesh can have the shape of the lower surfaceof the lower half of a torus. This is analogous to the lower surface ofa half of a bagel lying flat on a surface. In an example, thecross-sectional area of the valve can be between 5% to 15% of themaximum cross-sectional area of the half-torus mesh. In an example, thecross-sectional area of the valve can be between 10% to 30% of themaximum cross-sectional area of the half-torus mesh. In an example, ahalf-torus mesh can be created geometrically by rotating anupward-opening arc (e.g. a section of a circle, ellipsoid, or parabola)around a vertical axis (in space) which is to the right or left of thearc. In an example, a central portion of a half-torus mesh can comprisean upward-rising cone, analogous to the cone of a volcano, with thevalve being where the crater of a volcano would be. In an example, thehalf-torus mesh can radially-expand within the aneurysm sac to a widthwhich is greater than the width of the aneurysm neck.

In an example, a half-torus mesh can have uniform porosity. In anexample, a half-torus mesh can have a uniform durometer level. In anexample, a half-torus mesh can have uniform elasticity. In an example,the outer perimeter of a half-torus mesh can have greater porosity thanthe central portion of a half-torus mesh. In an example, the outerperimeter of a half-torus mesh can have a greater durometer level thanthe central portion of a half-torus mesh. In an example, the outerperimeter of a half-torus mesh can be more elastic than the centralportion of a half-torus mesh. In an example, the outer perimeter of ahalf-torus mesh can have lower porosity than the central portion of ahalf-torus mesh. In an example, the outer perimeter of a half-torus meshcan have a lower durometer level than the central portion of ahalf-torus mesh. In an example, the outer perimeter of a half-torus meshcan be less elastic than the central portion of a half-torus mesh.

In an example, a half-torus mesh can be a wire mesh and/or frame. In anexample, a half-torus mesh can have a single layer. In an example, ahalf-torus mesh can have two or more layers. In an example, a half-torusmesh can be a woven or braided wire mesh and/or frame. In an example, ahalf-torus mesh can be cut from metal. In an example, a half-torus meshcan be made from metal and polymer components. In an example, ahalf-torus mesh can comprise a wire frame and a polymer mesh. In anexample, a half-torus mesh can comprise a wire frame and a polymerlayer. In an example, a half-torus mesh can be made from nitinol.

In an example, a valve can be in the cross-sectional center of thehalf-torus mesh. In an example, a valve can be a leaflet valve. In anexample, a valve can be a bi-leaflet valve or tri-leaflet valve,analogous to a heart valve. In an example, a valve can passively openwhen an embolic member is pushed through it and can passively closeafter the member passes through or when a portion of the member isdetached. In an example, such a valve allows an embolic member to beinserted into an aneurysm after the half-torus mesh has been expanded inthe aneurysm, but the valve closes to reduce blood flow into theaneurysm after the embolic member has passed through the valve. In analternative example, an active valve can be remotely opened and/orclosed by the operator of the device. In an example, an active valve canbe remotely opened and/or closed by an operator by the application ofelectromagnetic energy. In an example, an active valve can be remotelyopened and/or closed by an operator by pulling a filament. In anexample, an active valve can be remotely opened and/or closed by anoperator by pushing, pulling, or rotating a wire. In an example, anactive valve can be remotely opened and/or closed by an operator bycutting, pulling, or pushing a flap or plug.

FIG. 22 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a toroidal mesh 2201 which is configured to beradially-expanded within an aneurysm to bridge the aneurysm neck; avalve 2202 in the toroidal mesh; and a catheter 2203 through whichembolic members (e.g. coils, hydrogels, microsponges, beads, orstring-of-pearls strands) are inserted through the valve into theaneurysm. After the embolic members have been inserted, the valve isclosed and the catheter is removed.

In an example, a toroidal mesh can have the shape of the outer surfaceof a torus. This is analogous to the outer surface of a bagel. In anexample, the cross-sectional area of the valve can be between 5% to 15%of the maximum cross-sectional area of the toroidal mesh. In an example,the cross-sectional area of the valve can be between 10% to 30% of themaximum cross-sectional area of the toroidal mesh. In an example, atoroidal mesh can be created geometrically by rotating a circle orellipsoid around a vertical axis (in space) which is to the right orleft of the circle or ellipsoid. In an example, a central portion of atoroidal mesh can have a hyperbolic shape. In an example, the toroidalmesh can radially-expand within the aneurysm sac to a width which isgreater than the width of the aneurysm neck.

In an example, a toroidal mesh can have uniform porosity. In an example,a toroidal mesh can have a uniform durometer level. In an example, atoroidal mesh can have uniform elasticity. In an example, the outerperimeter of a toroidal mesh can have greater porosity than the centralportion of a toroidal mesh. In an example, the outer perimeter of atoroidal mesh can have a greater durometer level than the centralportion of a toroidal mesh. In an example, the outer perimeter of atoroidal mesh can be more elastic than the central portion of a toroidalmesh. In an example, the outer perimeter of a toroidal mesh can havelower porosity than the central portion of a toroidal mesh. In anexample, the outer perimeter of a toroidal mesh can have a lowerdurometer level than the central portion of a toroidal mesh. In anexample, the outer perimeter of a toroidal mesh can be less elastic thanthe central portion of a toroidal mesh.

In an example, a toroidal mesh can be a wire mesh and/or frame. In anexample, a toroidal mesh can have a single layer. In an example, atoroidal mesh can have two or more layers. In an example, a toroidalmesh can be a woven or braided wire mesh and/or frame. In an example, atoroidal mesh can be cut from metal. In an example, a toroidal mesh canbe made from metal and polymer components. In an example, a toroidalmesh can comprise a wire frame and a polymer mesh. In an example, atoroidal mesh can comprise a wire frame and a polymer layer. In anexample, a toroidal mesh can be made from nitinol.

In an example, a valve can be in the cross-sectional center of thetoroidal mesh. In an example, a valve can be in a hyperbolic openingthrough the toroidal mesh. In an example, a valve can be a leafletvalve. In an example, a valve can be a bi-leaflet valve or tri-leafletvalve, analogous to a heart valve. In an example, a valve can passivelyopen when an embolic member is pushed through it and can passively closeafter the member passes through or when a portion of the member isdetached. In an example, such a valve allows an embolic member to beinserted into an aneurysm after the toroidal mesh has been expanded inthe aneurysm, but the valve closes to reduce blood flow into theaneurysm after the embolic member has passed through the valve. In analternative example, an active valve can be remotely opened and/orclosed by the operator of the device. In an example, an active valve canbe remotely opened and/or closed by an operator by the application ofelectromagnetic energy. In an example, an active valve can be remotelyopened and/or closed by an operator by pulling a filament. In anexample, an active valve can be remotely opened and/or closed by anoperator by pushing, pulling, or rotating a wire. In an example, anactive valve can be remotely opened and/or closed by an operator bycutting, pulling, or pushing a flap or plug.

FIG. 23 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a bowl-shaped mesh 2301 which is configured to beradially-expanded within an aneurysm to bridge the aneurysm neck; avalve 2302 in the bowl-shaped mesh; and a catheter 2303 through whichembolic members (e.g. coils, hydrogels, microsponges, beads, orstring-of-pearls strands) are inserted through the valve into theaneurysm. After the embolic members have been inserted, the valve isclosed and the catheter is removed.

In an example, a bowl-shaped mesh can be shaped like a lower section ofa sphere or ellipsoid. In an example, a bowl-shaped mesh can have ahemi-spherical or hemi-ellipsoidal shape. In an example, a bowl-shapedmesh can be a wire mesh and/or frame. In an example, a bowl-shaped meshcan have a single layer. In an example, a bowl-shaped mesh can have twoor more layers. In an example, a bowl-shaped mesh can be a woven orbraided wire mesh and/or frame. In an example, a bowl-shaped mesh can becut from metal. In an example, a bowl-shaped mesh can be made from metaland polymer components. In an example, a bowl-shaped mesh can comprise awire frame and a polymer mesh. In an example, a bowl-shaped mesh cancomprise a wire frame and a polymer layer. In an example, a bowl-shapedmesh can be made from nitinol. In an example, the bowl-shaped mesh canradially-expand within the aneurysm sac to a width which is greater thanthe width of the aneurysm neck.

In an example, a bowl-shaped mesh can have uniform porosity. In anexample, a bowl-shaped mesh can have a uniform durometer level. In anexample, a bowl-shaped mesh can have uniform elasticity. In an example,the outer perimeter of a bowl-shaped mesh can have greater porosity thanthe central portion of a bowl-shaped mesh. In an example, the outerperimeter of a bowl-shaped mesh can have a greater durometer level thanthe central portion of a bowl-shaped mesh. In an example, the outerperimeter of a bowl-shaped mesh can be more elastic than the centralportion of a bowl-shaped mesh. In an example, the outer perimeter of abowl-shaped mesh can have lower porosity than the central portion of abowl-shaped mesh. In an example, the outer perimeter of a bowl-shapedmesh can have a lower durometer level than the central portion of abowl-shaped mesh. In an example, the outer perimeter of a bowl-shapedmesh can be less elastic than the central portion of a bowl-shaped mesh.

In an example, a valve can be in the cross-sectional center of abowl-shaped mesh. In an example, a valve can be in a hyperbolic-shapedopening through a bowl-shaped mesh. In an example, the cross-sectionalarea of a valve can be between 5% to 15% of the maximum cross-sectionalarea of the bowl-shaped mesh. In an example, the cross-sectional area ofa valve can be between 10% to 30% of the maximum cross-sectional area ofthe bowl-shaped mesh. In an example, a valve can be a leaflet valve. Inan example, a valve can be a bi-leaflet valve or tri-leaflet valve,analogous to a heart valve.

In an example, a valve can passively open when an embolic member ispushed through it and can passively close after the member passesthrough or when a portion of the member is detached. In an example, sucha valve allows an embolic member to be inserted into an aneurysm afterthe bowl-shaped mesh has been expanded in the aneurysm, but the valvecloses to reduce blood flow into the aneurysm after the embolic memberhas passed through the valve. In an alternative example, an active valvecan be remotely opened and/or closed by the operator of the device. Inan example, an active valve can be remotely opened and/or closed by anoperator by the application of electromagnetic energy. In an example, anactive valve can be remotely opened and/or closed by an operator bypulling a filament. In an example, an active valve can be remotelyopened and/or closed by an operator by pushing, pulling, or rotating awire. In an example, an active valve can be remotely opened and/orclosed by an operator by cutting, pulling, or pushing a flap or plug.

FIG. 24 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a hyperbolic (or dumbbell or hour-glass) shaped mesh 2401which is configured to be radially-expanded within an aneurysm to bridgethe aneurysm neck; a valve 2402 in the hyperbolic shaped mesh; and acatheter 2403 through which embolic members (e.g. coils, hydrogels,microsponges, beads, or string-of-pearls strands) are inserted throughthe valve into the aneurysm. After the embolic members have beeninserted, the valve is closed and the catheter is removed.

In an example, a hyperbolic (or dumbbell or hour-glass) shaped mesh canbe a wire mesh and/or frame. In an example, a hyperbolic shaped mesh canhave a single layer. In an example, a hyperbolic shaped mesh can havetwo or more layers. In an example, a hyperbolic shaped mesh can be awoven or braided wire mesh and/or frame. In an example, a hyperbolicshaped mesh can be cut from metal. In an example, a hyperbolic shapedmesh can be made from metal and polymer components. In an example, ahyperbolic shaped mesh can comprise a wire frame and a polymer mesh. Inan example, a hyperbolic shaped mesh can comprise a wire frame and apolymer layer. In an example, a hyperbolic shaped mesh can be made fromnitinol. In an example, the hyperbolic shaped mesh can radially-expandwithin the aneurysm sac to a width which is greater than the width ofthe aneurysm neck.

In an example, a hyperbolic (or dumbbell or hour-glass) shaped mesh canhave uniform porosity. In an example, a hyperbolic (or dumbbell orhour-glass) shaped mesh can have a uniform durometer level. In anexample, a hyperbolic shaped mesh can have uniform elasticity. In anexample, the outer perimeter of a hyperbolic shaped mesh can havegreater porosity than the central portion of a hyperbolic shaped mesh.In an example, the outer perimeter of a hyperbolic shaped mesh can havea greater durometer level than the central portion of a hyperbolicshaped mesh. In an example, the outer perimeter of a hyperbolic shapedmesh can be more elastic than the central portion of a hyperbolic shapedmesh. In an example, the outer perimeter of a hyperbolic shaped mesh canhave lower porosity than the central portion of a hyperbolic shapedmesh. In an example, the outer perimeter of a hyperbolic shaped mesh canhave a lower durometer level than the central portion of a hyperbolicshaped mesh. In an example, the outer perimeter of a hyperbolic shapedmesh can be less elastic than the central portion of a hyperbolic shapedmesh.

In an example, a valve in a hyperbolic (or dumbbell or hour-glass)shaped mesh can be off-center. In an example, a valve in a hyperbolicshaped mesh can be offset from the central longitudinal axis of themesh. In an example, there can be two or more off-center valves througha hyperbolic mesh. In an example, the cross-sectional area of a valvecan be between 5% to 15% of the maximum cross-sectional area of thehyperbolic shaped mesh. In an example, the cross-sectional area of avalve can be between 10% to 30% of the maximum cross-sectional area ofthe hyperbolic shaped mesh. In an example, a valve can be a leafletvalve. In an example, a valve can be a bi-leaflet valve or tri-leafletvalve, analogous to a heart valve.

In an example, a valve can passively open when an embolic member ispushed through it and can passively close after the member passesthrough or when a portion of the member is detached. In an example, sucha valve allows an embolic member to be inserted into an aneurysm afterthe hyperbolic (or dumbbell or hour-glass) shaped mesh has been expandedin the aneurysm, but the valve closes to reduce blood flow into theaneurysm after the embolic member has passed through the valve. In analternative example, an active valve can be remotely opened and/orclosed by the operator of the device. In an example, an active valve canbe remotely opened and/or closed by an operator by the application ofelectromagnetic energy. In an example, an active valve can be remotelyopened and/or closed by an operator by pulling a filament. In anexample, an active valve can be remotely opened and/or closed by anoperator by pushing, pulling, or rotating a wire. In an example, anactive valve can be remotely opened and/or closed by an operator bycutting, pulling, or pushing a flap or plug.

FIG. 25 shows an intrasacular device for occluding a cerebral aneurysmcomprising: an inner convex mesh 2501 which is configured to beradially-expanded within an aneurysm; an outer convex mesh (or net) 2502which is configured to be radially-expanded within the aneurysm, whereinthe inner convex mesh is inside the outer convex mesh; a valve 2503 inthe outer convex mesh (or net); and a catheter 2504 through whichembolic members (e.g. coils, hydrogels, microsponges, beads, orstring-of-pearls strands) are inserted into the space between the innerconvex mesh and the outer convex mesh. After the embolic members havebeen inserted, the valve is closed and the catheter is removed.

In an example, an inner convex mesh can be spherical. In an example, aninner convex mesh can be ellipsoidal. In an example, an inner convexmesh can be apple, barrel, or pear shaped. In an example, an innerconvex mesh can be toroidal. In an example, an inner convex mesh can behyperbolic, dumbbell, peanut, or hour-glass shaped. In an example, aninner convex mesh can be disk shaped. In an example, an inner convexmesh can be shaped like a paper lantern. In an example, an inner convexmesh can be a wire mesh and/or frame. In an example, an inner convexmesh can be a woven or braided wire mesh and/or frame. In an example, aninner convex mesh can be made from metal and polymer components. In anexample, an outer convex mesh (or net) can be spherical. In an example,an outer convex mesh can be ellipsoidal. In an example, an outer convexmesh can be apple, barrel, or pear shaped. In an example, an outerconvex mesh can be shaped like a paper lantern. In an example, an outerconvex mesh can be a wire mesh and/or frame. In an example, an outerconvex mesh can be a woven or braided wire mesh and/or frame.

In an example, an outer convex mesh (or net) can be made from metal andpolymer components. In an example, an inner convex mesh can be made froma metal and an outer convex mesh can be made from a polymer. In anexample, inner and outer convex meshes can be nested. In an example,inner and outer convex meshes can be concentric. In an example, innerand outer convex meshes can be attached to each other. In an example,the proximal ends of inner and outer convex meshes can be attached toeach other. In an example, the distal ends of inner and outer convexmeshes can be attached to each other. In an example: the proximal endsof inner and outer convex meshes can be attached to each other; and thedistal ends of inner and outer convex meshes can be attached to eachother.

In an example, inner and outer convex meshes can both have the samedurometer level. In an example, inner and outer convex meshes can bothhave the same elasticity. In an example, inner and outer convex meshescan both have the same porosity. In an example, an outer convex mesh (ornet) can be less elastic than an inner convex mesh. In an example, anouter convex mesh can have a greater durometer level than an innerconvex mesh. In an example, an outer convex mesh can have greaterporosity than an inner convex mesh. In an example, an outer convex meshcan be more elastic than an inner convex mesh. In an example, an outerconvex mesh can have a lower durometer level an inner convex mesh. In anexample, an outer convex mesh can have lower porosity than an innerconvex mesh.

In an example, a valve in an outer convex mesh (or net) can beoff-center. In an example, a valve in an outer convex mesh (or net) canbe offset from the central longitudinal axis of the mesh. In an example,there can be two or more off-center valves through a outer convex mesh.Alternatively, a valve in an outer convex mesh can be central to thecross-section of an outer convex mesh. In an example, a valve in anouter convex mesh can on the central longitudinal axis of the mesh. Inan example, the cross-sectional area of a valve can be between 5% to 15%of the maximum cross-sectional area of an outer convex mesh. In anexample, the cross-sectional area of a valve can be between 10% to 30%of the maximum cross-sectional area of an outer convex mesh. In anexample, a valve can be a leaflet valve. In an example, a valve can be abi-leaflet valve or tri-leaflet valve, analogous to a heart valve.

In an example, a valve can passively open when an embolic member ispushed through it and can passively close after the member passesthrough or when a portion of the member is detached. In an example, sucha valve allows an embolic member to be inserted into an aneurysm, butthe valve closes to reduce blood flow into the aneurysm after theembolic member has passed through the valve. In an example, an activevalve can be remotely opened and/or closed by the operator of thedevice. In an example, an active valve can be remotely opened and/orclosed by an operator by the application of electromagnetic energy. Inan example, an active valve can be remotely opened and/or closed by anoperator by pulling a filament. In an example, an active valve can beremotely opened and/or closed by an operator by pushing, pulling, orrotating a wire. In an example, an active valve can be remotely openedand/or closed by an operator by cutting, pulling, or pushing a flap orplug.

FIG. 26 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a metal mesh (or frame) 2601 which is configured to beradially-expanded within an aneurysm; a polymer net (or liner) 2602which is configured to be radially-expanded within the aneurysm, whereinthe metal mesh is inside the polymer net; a valve 2603 in the polymernet; and a catheter 2604 through which embolic members (e.g. coils,hydrogels, microsponges, beads, or string-of-pearls strands) areinserted into the space between the metal mesh and the polymer net.After the embolic members have been inserted, the valve is closed andthe catheter is removed.

In an example, a metal mesh (or frame) can be spherical. In an example,a metal mesh can be ellipsoidal. In an example, a metal mesh can beapple, barrel, or pear shaped. In an example, a metal mesh can betoroidal. In an example, a metal mesh can be hyperbolic, dumbbell,peanut, or hour-glass shaped. In an example, a metal mesh can be diskshaped. In an example, a metal mesh can be shaped like a paper lantern.In an example, a metal mesh can be a wire mesh and/or frame. In anexample, a metal mesh can be a woven or braided wire mesh and/or frame.In an example, a metal mesh can be a ball stent. In an example, a metalmesh can be made from metal and polymer components. In an example, apolymer net can be spherical. In an example, a polymer net can beellipsoidal. In an example, a polymer net can be apple, barrel, or pearshaped. In an example, a polymer net can be shaped like a paper lantern.In an example, a polymer net can be a wire mesh and/or frame. In anexample, a polymer net can be a woven or braided wire mesh and/or frame.

In an example, a polymer net can be made from metal and polymercomponents. In an example, a metal mesh can be made from a metal and apolymer net can be made from a polymer. In an example, a metal mesh anda polymer net can be nested. In an example, metal mesh and polymer netcan be concentric. In an example, a metal mesh and a polymer net can beattached to each other. In an example, the proximal end of a metal meshand the proximal end of a polymer net can be attached to each other. Inan example, the distal end of a metal mesh and the distal end of apolymer net can be attached to each other. In an example: the proximalend of a metal mesh and the proximal end of a polymer net can beattached to each other; and the proximal end of a metal mesh and theproximal end of a polymer net can be attached to each other.

In an example, a metal mesh and a polymer net can both have the samedurometer level. In an example, a metal mesh and a polymer net can bothhave the same elasticity. In an example, a metal mesh and a polymer netcan both have the same porosity. In an example, a polymer net can beless elastic than a metal mesh. In an example, a polymer net can have agreater durometer level than a metal mesh. In an example, a polymer netcan have greater porosity than a metal mesh. In an example, a polymernet can be more elastic than a metal mesh. In an example, a polymer netcan have a lower durometer level a metal mesh. In an example, a polymernet can have lower porosity than a metal mesh.

In an example, a valve in a polymer net can be off-center. In anexample, a valve in a polymer net can be offset from the centrallongitudinal axis of the net. In an example, there can be two or moreoff-center valves through a polymer net. Alternatively, a valve in apolymer net can be central to the cross-section of the polymer net. Inan example, a valve in a polymer net can on the central longitudinalaxis of the net. In an example, the cross-sectional area of a valve canbe between 5% to 15% of the maximum cross-sectional area of a polymernet. In an example, the cross-sectional area of a valve can be between10% to 30% of the maximum cross-sectional area of a polymer net. In anexample, a valve can be a leaflet valve. In an example, a valve can be abi-leaflet valve or tri-leaflet valve, analogous to a heart valve.

In an example, a valve can passively open when an embolic member ispushed through it and can passively close after the member passesthrough or when a portion of the member is detached. In an example, sucha valve allows an embolic member to be inserted into an aneurysm, butthe valve closes to reduce blood flow into the aneurysm after theembolic member has passed through the valve. In an example, an activevalve can be remotely opened and/or closed by the operator of thedevice. In an example, an active valve can be remotely opened and/orclosed by an operator by the application of electromagnetic energy. Inan example, an active valve can be remotely opened and/or closed by anoperator by pulling a filament. In an example, an active valve can beremotely opened and/or closed by an operator by pushing, pulling, orrotating a wire. In an example, an active valve can be remotely openedand/or closed by an operator by cutting, pulling, or pushing a flap orplug.

FIG. 27 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a distal mesh 2703 which is configured to beradially-expanded within the dome of an aneurysm 2701; and a proximalmesh 2702 which is configured to be radially-expanded to bridge the neckof the aneurysm; wherein a proximal portion of the distal mesh is nestedwithin a concavity of the proximal mesh, wherein proximal means closerto the aneurysm neck, and wherein distal means farther from the aneurysmneck.

In an example, a proximal portion of a distal mesh can fit inside adistal concavity of a proximal mesh. In an example, a proximal portionof a distal mesh can be nested within a distal concavity of a proximalmesh. In an example, a proximal mesh can overlap a proximal portion of adistal mesh. In an example, between 20% and 40% of the surface of adistal mesh can be nested within a concavity of a proximal mesh. In anexample, between 30% and 66% of the surface of a distal mesh can benested within a concavity of a proximal mesh. In an example, distal andproximal meshes can be coaxial. In an example, the distal mesh and theproximal mesh can share a common longitudinal axis. In an example, aproximal portion of a distal mesh can be attached to a proximal mesh. Inan example, a proximal portion of a distal mesh can be fused to aportion of the proximal mesh by the application of electromagneticenergy. In an example, a proximal portion of a distal mesh can beattached to a portion of a proximal mesh by a wire, string, suture, orother filament.

In an example, a distal mesh can be globular. In an example, a distalmesh can be spherical. In an example, a distal mesh can be ellipsoidal.In an example, a distal mesh can be disk shaped. In an example, a distalmesh can be toroidal. In an example, a distal mesh can be apple, barrel,or pear shaped. In an example, a distal mesh can be hyperbolic,hour-glass, dumbbell, or peanut shaped. In an example, a distal mesh canbe shaped like a paper lantern. In an example, a proximal mesh can be aportion of a sphere or ellipsoid. In an example, a proximal mesh can bebowl shaped. In an example, a proximal mesh can be hemispherical. In anexample, a proximal mesh can be parabolic. In an example, a proximalmesh can be a conic section.

In an example, a proximal mesh can be expanded to a diameter which isgreater than the diameter of an aneurysm neck. In an example, a proximalmesh can be expanded to a diameter which is at least 90% of the maximumdiameter of an aneurysm sac. In an example, a proximal mesh can beexpanded to a circumference which is greater than the circumference ofan aneurysm neck. In an example, a proximal mesh can be expanded to acircumference which is at least 90% of the maximum circumference of ananeurysm sac. In an example, a distal mesh can be expanded to a diameterwhich is between 90% and 100% of the diameter of a proximal mesh. In anexample, a proximal mesh can be expanded to a circumference which isbetween 90% and 100% of the circumference of a proximal mesh.

In an example, a distal mesh can be a wire mesh. In an example, a distalmesh can be a wire frame. In an example, a distal mesh can be a stent.In an example, a distal mesh can be woven or braided. In an example, adistal mesh can be made from metal. In an example, a distal mesh can bemade from a polymer. In an example, a distal mesh can be made from bothmetal and polymer components. In an example, a proximal mesh can be awire mesh. In an example, a proximal mesh can be a wire frame. In anexample, a proximal mesh can be a stent. In an example, a proximal meshcan be woven or braided. In an example, a proximal mesh can be made frommetal. In an example, a proximal mesh can be made from a polymer. In anexample, a proximal mesh can be made from both metal and polymercomponents.

In an example, proximal and distal meshes can both have the samedurometer level. In an example, proximal and distal meshes can both havethe same elasticity. In an example, proximal and distal meshes can bothhave the same porosity. In an example, a distal mesh can be less elasticthan a proximal mesh. In an example, a distal mesh can have a greaterdurometer level than a proximal mesh. In an example, a distal mesh canhave greater porosity than a proximal mesh. In an example, a distal meshcan be more elastic than a proximal mesh. In an example, a distal meshcan have a lower durometer level a proximal mesh. In an example, adistal mesh can have lower porosity than a proximal mesh.

FIG. 28 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a distal mesh 2803 which is configured to beradially-expanded within the dome of an aneurysm 2801; and a proximalmesh 2802 which is configured to be radially-expanded to bridge the neckof the aneurysm; wherein the proximal end of the distal mesh is attachedto the distal end of the proximal mesh, wherein proximal means closer tothe aneurysm neck, and wherein distal means farther from the aneurysmneck. In an example, distal and proximal meshes can be coaxial. In anexample, the distal mesh and the proximal mesh can share a commonlongitudinal axis. In an example, the proximal end of a distal mesh canbe fused to the distal end of the proximal mesh by the application ofelectromagnetic energy. In an example, the proximal end of a distal meshcan be attached to the distal end of the proximal mesh by a wire,string, suture, or other filament.

In an example, both proximal and distal meshes can be ellipsoidal. In anexample, both proximal and distal meshes can be spherical. In anexample, a distal mesh can be spherical. In an example, a proximal meshcan be spherical. In an example, a distal mesh can be apple, barrel, orpear shaped. In an example, a proximal mesh can be apple, barrel, orpear shaped. In an example, both proximal and distal meshes can beapple, barrel, or pear shaped. In an example, a distal mesh can be diskshaped. In an example, a proximal mesh can be disk shaped. In anexample, both proximal and distal meshes can be disk shaped. In anexample, a distal mesh can be ellipsoidal. In an example, a proximalmesh can be ellipsoidal.

In an example, both proximal and distal meshes can be globular. In anexample, a distal mesh can be globular. In an example, a proximal meshcan be globular. In an example, a distal mesh can be hyperbolic,hour-glass, dumbbell, or peanut shaped. In an example, a proximal meshcan be hyperbolic, hour-glass, dumbbell, or peanut shaped. In anexample, both proximal and distal meshes can be hyperbolic, hour-glass,dumbbell, or peanut shaped. In an example, a distal mesh can be shapedlike a paper lantern. In an example, a proximal mesh can be shaped likea paper lantern. In an example, both proximal and distal meshes can beshaped like a paper lantern. In an example, a distal mesh can betoroidal. In an example, a proximal mesh can be toroidal. In an example,both proximal and distal meshes can be toroidal.

In an example, both proximal and distal meshes can be the same size. Inan example, a proximal mesh can be larger than a distal mesh. In anexample, a proximal mesh can be between 10% and 30% larger than a distalmesh. In an example, a proximal mesh can be between 25% and 75% largerthan a distal mesh. In an example, a distal mesh can be a wire mesh. Inan example, a distal mesh can be a wire frame. In an example, a distalmesh can be a stent. In an example, a distal mesh can be woven orbraided. In an example, a distal mesh can be made from metal. In anexample, a distal mesh can be made from a polymer.

In an example, a distal mesh can be made from both metal and polymercomponents. In an example, a proximal mesh can be a wire mesh. In anexample, a proximal mesh can be a wire frame. In an example, a proximalmesh can be a stent. In an example, a proximal mesh can be woven orbraided. In an example, a proximal mesh can be made from metal. In anexample, a proximal mesh can be made from a polymer. In an example, aproximal mesh can be made from both metal and polymer components. In anexample, a distal mesh can be larger than a proximal mesh. In anexample, a distal mesh can be between 10% and 30% larger than a proximalmesh. In an example, a distal mesh can be between 25% and 75% largerthan a proximal mesh.

In an example, proximal and distal meshes can both have the samedurometer level. In an example, proximal and distal meshes can both havethe same elasticity. In an example, proximal and distal meshes can bothhave the same porosity. In an example, a distal mesh can be less elasticthan a proximal mesh. In an example, a distal mesh can have a greaterdurometer level than a proximal mesh. In an example, a distal mesh canhave greater porosity than a proximal mesh. In an example, a distal meshcan be more elastic than a proximal mesh. In an example, a distal meshcan have a lower durometer level a proximal mesh. In an example, adistal mesh can have lower porosity than a proximal mesh.

FIG. 29 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a distal mesh 2903 which is configured to beradially-expanded within the sac of an aneurysm 2901; and a proximalmesh 2902 which is configured to be radially-expanded to bridge the neckof the aneurysm; wherein the proximal end of the distal mesh is attachedto the distal end of the proximal mesh, wherein proximal means closer tothe aneurysm neck, and wherein distal means farther from the aneurysmneck. In an example, distal and proximal meshes can be coaxial. In anexample, the distal mesh and the proximal mesh can share a commonlongitudinal axis. In an example, the proximal end of a distal mesh canbe fused to the distal end of the proximal mesh by the application ofelectromagnetic energy. In an example, the proximal end of a distal meshcan be attached to the distal end of the proximal mesh by a wire,string, suture, or other filament.

In an example, both proximal and distal meshes can be ellipsoidal. In anexample, a distal mesh can be disk shaped. In an example, a proximalmesh can be disk shaped. In an example, both proximal and distal meshescan be disk shaped. In an example, a distal mesh can be ellipsoidal. Inan example, a proximal mesh can be ellipsoidal. In an example, a distalmesh can be shaped like a paper lantern. In an example, a proximal meshcan be shaped like a paper lantern. In an example, both proximal anddistal meshes can be shaped like a paper lantern. In an example, adistal mesh can be toroidal. In an example, a proximal mesh can betoroidal. In an example, both proximal and distal meshes can betoroidal.

In an example, both proximal and distal meshes can be the same size. Inan example, a proximal mesh can be larger than a distal mesh. In anexample, a proximal mesh can be between 10% and 30% larger than a distalmesh. In an example, a proximal mesh can be between 25% and 75% largerthan a distal mesh. In an example, a distal mesh can be a wire mesh. Inan example, a distal mesh can be a wire frame. In an example, a distalmesh can be a stent. In an example, a distal mesh can be woven orbraided. In an example, a distal mesh can be made from metal. In anexample, a distal mesh can be made from a polymer.

In an example, a distal mesh can be made from both metal and polymercomponents. In an example, a proximal mesh can be a wire mesh. In anexample, a proximal mesh can be a wire frame. In an example, a proximalmesh can be a stent. In an example, a proximal mesh can be woven orbraided. In an example, a proximal mesh can be made from metal. In anexample, a proximal mesh can be made from a polymer. In an example, aproximal mesh can be made from both metal and polymer components. In anexample, a distal mesh can be larger than a proximal mesh. In anexample, a distal mesh can be between 10% and 30% larger than a proximalmesh. In an example, a distal mesh can be between 25% and 75% largerthan a proximal mesh.

In an example, proximal and distal meshes can both have the samedurometer level. In an example, proximal and distal meshes can both havethe same elasticity. In an example, proximal and distal meshes can bothhave the same porosity. In an example, a distal mesh can be less elasticthan a proximal mesh. In an example, a distal mesh can have a greaterdurometer level than a proximal mesh. In an example, a distal mesh canhave greater porosity than a proximal mesh. In an example, a distal meshcan be more elastic than a proximal mesh. In an example, a distal meshcan have a lower durometer level a proximal mesh. In an example, adistal mesh can have lower porosity than a proximal mesh.

FIG. 30 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a double-layer bowl-shaped mesh 3002 which is configured tobe radially-expanded to bridge the neck of an aneurysm 3001; and a valve3003 in the double-layer bowl-shaped mesh through which embolic members(e.g. embolic coils, hydrogels, microsponges, beads, or string-of-pearlsembolic strands) or liquid embolic material (which solidifies in theaneurysm) can be inserted into the aneurysm.

In an example, a bowl-shaped mesh can have uniform elasticity. In anexample, a bowl-shaped mesh can have uniform porosity. In an example, abowl-shaped mesh can have a uniform durometer level. In an example, acentral portion of a bowl-shaped mesh can have a greater durometer levelthan a peripheral portion of a bowl-shaped mesh. In an example, theouter perimeter of a bowl-shaped mesh can have a greater durometer levelthan the central portion of a bowl-shaped mesh. In an example, a centralportion of a bowl-shaped mesh can have a lower durometer level aperipheral portion of a bowl-shaped mesh. In an example, the outerperimeter of a bowl-shaped mesh can have a lower durometer level thanthe central portion of a bowl-shaped mesh. In an example, layers of abowl-shaped mesh can be closer together near the center of thebowl-shaped mesh and farther apart around the periphery of thebowl-shaped mesh.

In an example, a central portion of a bowl-shaped mesh can have greaterporosity than a peripheral portion of a bowl-shaped mesh. In an example,the outer perimeter of a bowl-shaped mesh can have greater porosity thanthe central portion of a bowl-shaped mesh. In an example, a centralportion of a bowl-shaped mesh can have lower porosity than a peripheralportion of a bowl-shaped mesh. In an example, the outer perimeter of abowl-shaped mesh can have lower porosity than the central portion of abowl-shaped mesh. In an example, a central portion of a bowl-shaped meshcan be more elastic than a peripheral portion of a bowl-shaped mesh. Inan example, the outer perimeter of a bowl-shaped mesh can be moreelastic than the central portion of a bowl-shaped mesh. In an example,the outer perimeter of a bowl-shaped mesh can be less elastic than thecentral portion of a bowl-shaped mesh. In an example, layers of abowl-shaped mesh can be farther apart near the center of the bowl-shapedmesh and closer together in the periphery of the bowl-shaped mesh.

In an example, a valve in a bowl-shaped mesh can be central to thecross-section of the bowl-shaped mesh. In an example, thecross-sectional area of a valve can be between 5% to 15% of the maximumcross-sectional area of a bowl-shaped mesh. In an example, thecross-sectional area of a valve can be between 10% to 30% of the maximumcross-sectional area of a bowl-shaped mesh. In an example, a valve canbea leaflet valve. In an example, a valve can be a bi-leaflet valve ortri-leaflet valve, analogous to a heart valve.

In an example, a valve can passively open when an embolic member ispushed through it and can passively close after the member passesthrough or when a portion of the member is detached. In an example, sucha valve allows an embolic member to be inserted into an aneurysm, butthe valve closes to reduce blood flow into the aneurysm after theembolic member has passed through the valve. In an example, an activevalve can be remotely opened and/or closed by the operator of thedevice. In an example, an active valve can be remotely opened and/orclosed by an operator by the application of electromagnetic energy. Inan example, an active valve can be remotely opened and/or closed by anoperator by pulling a filament. In an example, an active valve can beremotely opened and/or closed by an operator by pushing, pulling, orrotating a wire. In an example, an active valve can be remotely openedand/or closed by an operator by cutting, pulling, or pushing a flap orplug.

FIG. 31 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a proximal bowl-shaped mesh 3102 which is configured to beradially-expanded to bridge the neck of an aneurysm 3101; a distalflexible net (or mesh) 3104 which is nested within a concavity of thebowl-shaped mesh, wherein the distal flexible net expands to fill thedome of the aneurysm; and a valve 3103 in the proximal bowl-shaped meshthrough which embolic members (e.g. embolic coils, hydrogels,microsponges, beads, or string-of-pearls embolic strands) pass into thedistal flexible net. In an example, the distal flexible net and theproximal bowl-shaped mesh can be connected. In an example, the distalflexible net and the proximal bowl-shaped mesh can be centrallyconnected. In an example, the distal flexible net and the proximalbowl-shaped mesh can both be connected to the valve.

In an example, a valve in a bowl-shaped mesh can be central to thecross-section of the bowl-shaped mesh. In an example, a valve in abowl-shaped mesh can on the central longitudinal axis of the distalflexible net. In an example, the cross-sectional area of a valve can bebetween 5% to 15% of the maximum cross-sectional area of a bowl-shapedmesh. In an example, the cross-sectional area of a valve can be between10% to 30% of the maximum cross-sectional area of a bowl-shaped mesh. Inan example, a valve can be a leaflet valve. In an example, a valve canbe a bi-leaflet valve or tri-leaflet valve, analogous to a heart valve.

In an example, a valve can passively open when an embolic member ispushed through it and can passively close after the member passesthrough or when a portion of the member is detached. In an example, sucha valve allows an embolic member to be inserted into the distal flexiblenet, but the valve closes to reduce blood flow after the embolic memberhas passed through the valve. In an example, an active valve can beremotely opened and/or closed by the operator of the device. In anexample, an active valve can be remotely opened and/or closed by anoperator by the application of electromagnetic energy. In an example, anactive valve can be remotely opened and/or closed by an operator bypulling a filament. In an example, an active valve can be remotelyopened and/or closed by an operator by pushing, pulling, or rotating awire. In an example, an active valve can be remotely opened and/orclosed by an operator by cutting, pulling, or pushing a flap or plug.

FIG. 32 shows an intrasacular device for occluding a cerebral aneurysmcomprising: a proximal bowl-shaped mesh 3202 which is configured to beradially-expanded to bridge the neck of an aneurysm 3201; a flexible net(or mesh) 3204 which expands to fill the dome of the aneurysm, whereinthe proximal bowl-shaped mesh is inside the flexible net; and a valve3203 in the flexible net through which embolic members (e.g. emboliccoils, hydrogels, microsponges, beads, or string-of-pearls embolicstrands) pass into the flexible net.

In an example, the flexible net and the proximal bowl-shaped mesh can beconnected. In an example, the flexible net and the proximal bowl-shapedmesh can be centrally connected. In an example, the flexible net and theproximal bowl-shaped mesh can both be connected to the valve. In anexample, the proximal bowl-shaped mesh can be made from metal and theflexible net (or mesh) can be made from a polymer. In an example, thecomposition of the proximal bowl-shaped mesh can have higher percentageof metal than the composition of the flexible net (or mesh). In anexample the proximal bowl-shaped mesh can be less porous than theflexible net (or mesh). In an example the proximal bowl-shaped mesh canbe less elastic than the flexible net (or mesh). In an example theproximal bowl-shaped mesh can have a lower durometer level than theflexible net (or mesh).

In an example, a valve can be a leaflet valve. In an example, a valvecan be a bi-leaflet valve or tri-leaflet valve, analogous to a heartvalve. In an example, a valve can passively open when an embolic memberis pushed through it and can passively close after the member passesthrough or when a portion of the member is detached. In an example, sucha valve allows an embolic member to be inserted into the flexible net,but the valve closes to reduce blood flow after the embolic member haspassed through the valve. In an example, an active valve can be remotelyopened and/or closed by the operator of the device. In an example, anactive valve can be remotely opened and/or closed by an operator by theapplication of electromagnetic energy. In an example, an active valvecan be remotely opened and/or closed by an operator by pulling afilament. In an example, an active valve can be remotely opened and/orclosed by an operator by pushing, pulling, or rotating a wire. In anexample, an active valve can be remotely opened and/or closed by anoperator by cutting, pulling, or pushing a flap or plug.

FIG. 33 shows two sequential views of an example of a leaflet valvewhich can be used in an intrasacular device for occluding a cerebralaneurysm. The left half of FIG. 33 shows this leaflet valve at a firstpoint in time when the valve is in its closed configuration. The righthalf of FIG. 33 shows this leaflet valve at a second point in time whenthe valve is in its open configuration. Specifically, FIG. 33 shows aleaflet valve 3301 and a central opening 3302 in the valve (when it isin its open configuration).

This is just one type of valve which can be used in any of in theintrasacular devices shown elsewhere in this disclosure orpriority-linked disclosures. In an example, this leaflet valve can bepositioned in an opening (or lumen) through a mesh (or net) whichbridges an aneurysm neck. When this leaflet valve is in its openconfiguration, embolic members (such as embolic coils, hydrogels,microsponges, beads, or string-of-pearls embolic strands) or liquidembolic material (which solidifies in the aneurysm) can be insertedthrough the opening in the mesh into an aneurysm. When this leafletvalve is in its closed configuration, it reduces blood flood through theopening in the mesh into the aneurysm. In other words, this leafletvalve can serve as a “closure mechanism” for an intrasacular aneurysmocclusion device.

In an example, a leaflet valve can be a bi-leaflet valve or tri-leafletvalve, analogous to a heart valve. In an example, a leaflet valve canhave a single leaflet or flap. In an example, a leaflet valve can havefour or more leaflets or flaps. In an example, a leaflet valve canpassively open when an embolic member (such as an embolic coil,hydrogel, microsponge, bead, or a string-of-pearls embolic strand)pushes through it. In an example, a leaflet valve can passively closewhen after the embolic member has passed through. In an example, aleaflet valve can be made from an elastomeric material. In an example, aleaflet valve can be made from a silicone-based polymer. In an example,a leaflet valve can be made from rigid material such as metal. In anexample, a leaflet valve can be made from titanium and carbon. In anexample, a leaflet valve can be remotely opened and/or closed by theoperator of the device. In an example, a leaflet valve can be remotelyopened and/or closed by an operator by the application ofelectromagnetic energy.

FIG. 34 shows two sequential views of an example of an elastic annularvalve which can be used in an intrasacular device for occluding acerebral aneurysm. The left half of FIG. 34 shows this elastic annularvalve at a first point in time when the valve is in its closedconfiguration. The right half of FIG. 34 shows this elastic annularvalve at a second point in time when the valve is in its openconfiguration. Specifically, FIG. 34 shows a leaflet elastic annularvalve 3401 and a central opening 3402 in the valve (when it is in itsopen configuration).

This is just one type of valve which can be used in any of in theintrasacular devices shown elsewhere in this disclosure orpriority-linked disclosures. In an example, this elastic annular valvecan be positioned in an opening (or lumen) through a mesh (or net) whichbridges an aneurysm neck. When this elastic annular valve is in its openconfiguration, embolic members (such as embolic coils, hydrogels,microsponges, beads, or string-of-pearls embolic strands) or liquidembolic material (which solidifies in the aneurysm) can be insertedthrough the opening in the mesh into an aneurysm. When this elasticannular valve is in its closed configuration, it reduces blood floodthrough the opening in the mesh into the aneurysm. In other words, thiselastic annular valve can serve as a “closure mechanism” for anintrasacular aneurysm occlusion device. We all have times when we needclosure.

In an example, a valve can be an elastic annular valve. In an example,an elastic annular valve can passively open when an embolic member (suchas an embolic coil, hydrogel, microsponge, bead, or a string-of-pearlsembolic strand) pushes through it. In an example, an elastic annularvalve can passively close when after the embolic member has passedthrough. In an example, an elastic annular valve can be made from anelastomeric material. In an example, an elastic annular valve can bemade from a silicone-based polymer.

FIG. 35 shows two sequential views of an example of a rotational valvewhich can be used in an intrasacular device for occluding a cerebralaneurysm. The left half of FIG. 35 shows this rotational valve at afirst point in time wherein the valve is in its closed configuration.The right half of FIG. 35 shows this rotational valve at a second pointin time wherein the valve is in its open configuration. Specifically,the rotational valve shown in FIG. 35 comprises an (outer) first layer3501 with a first opening (or hole) 3502 and an (inner) second layerwith a second opening (or hole) 3503.

When the first and second openings (holes) are not aligned, then thevalve is in its closed configuration. When the first and second openings(holes) are aligned, then the valve is in its open configuration. Inthis example, the valve is changed from its closed configuration to itsopen configuration, or vice versa, by rotating (or revolving, pivoting,turning, or twisting) the first layer relative to the second layer, orvice versa. In an example, a rotational valve can comprise two or moreoverlapping (e.g. parallel) layers with openings (holes). When theopenings (holes) of different layers are not aligned, then the valve isclosed. When the opening (holes) of different layers are aligned, thenthe valve is open. In an example, the valve can be opened or closed byrotating one layer relative to the other layer. In an example, one orboth layers can be rotated remotely by the operator of the device,enabling the operator to open or close the valve remotely.

This is just one type of valve which can be used in any of in theintrasacular devices shown elsewhere in this disclosure orpriority-linked disclosures. In an example, this rotational valve can bepositioned in an opening (or lumen) through a mesh (or net) whichbridges an aneurysm neck. When this rotational valve is in its openconfiguration, embolic members (such as embolic coils, hydrogels,microsponges, beads, or string-of-pearls embolic strands) or liquidembolic material (which solidifies in the aneurysm) can be insertedthrough the opening in the mesh into an aneurysm. When this rotationalvalve is in its closed configuration, it reduces blood flood through theopening in the mesh into the aneurysm. In other words, this rotationalvalve can serve as a “closure mechanism” for an intrasacular aneurysmocclusion device.

FIG. 36 shows two sequential views of an example of a sliding valvewhich can be used in an intrasacular device for occluding a cerebralaneurysm. The left half of FIG. 36 shows this sliding valve at a firstpoint in time wherein the valve is in its closed configuration. Theright half of FIG. 36 shows this sliding valve at a second point in timewherein the valve is in its open configuration. Specifically, thesliding valve shown in FIG. 36 comprises a layer 3601 with an opening(or hole) 3602 and a sliding flap (or lid) 3603. When the sliding flap(lid) covers the opening (hole), then the valve is in its closedconfiguration. When the sliding flap (lid) does not cover the opening(hole), then the valve is in its open configuration. In this example,the valve is changed from its closed configuration to its openconfiguration, or vice versa, by moving the sliding flap. In an example,the sliding flap can be moved remotely by the operator of the device,enabling the operator to open or close the valve remotely.

This is just one type of valve which can be used in any of in theintrasacular devices shown elsewhere in this disclosure orpriority-linked disclosures. In an example, this sliding valve can bepositioned in an opening (or lumen) through a mesh (or net) whichbridges an aneurysm neck. When this sliding valve is in its openconfiguration, embolic members (such as embolic coils, hydrogels,microsponges, beads, or string-of-pearls embolic strands) or liquidembolic material (which solidifies in the aneurysm) can be insertedthrough the opening in the mesh into an aneurysm. When this slidingvalve is in its closed configuration, it reduces blood flood through theopening in the mesh into the aneurysm. In other words, this slidingvalve can serve as a “closure mechanism” for an intrasacular aneurysmocclusion device.

FIG. 37 shows two sequential views of an example of a pivoting valvewhich can be used in an intrasacular device for occluding a cerebralaneurysm. The left half of FIG. 37 shows this pivoting valve at a firstpoint in time wherein the valve is in its closed configuration. Theright half of FIG. 37 shows this pivoting valve at a second point intime wherein the valve is in its open configuration. Specifically, thevalve shown in FIG. 37 comprises a lumen (opening) 3701 with a pivotingflap (or plug) 3702. When the pivoting flap (plug) blocks the lumen(opening), then the valve is in its closed configuration. When thepivoting flap (lid) does not block the lumen (opening), then the valveis in its open configuration. In this example, the valve is changed fromits closed configuration to its open configuration, or vice versa, bypivoting (rotating) the flap around a central axis. In the example of asquare opening, a valve could changed from its closed configuration toits open configuration, or vice versa, by pivoting (rotating) a flaparound one side. In an example, the pivoting flap can be moved remotelyby the operator of the device, enabling the operator to open or closethe valve remotely. This type of pivoting valve is analogous to thevalves which are used in circular air ducts for HVAC (heating,ventilation, and air conditioning) systems in buildings.

This is just one type of valve which can be used in any of in theintrasacular devices shown elsewhere in this disclosure orpriority-linked disclosures. In an example, this pivoting valve can bepositioned in an opening (or lumen) through a mesh (or net) whichbridges an aneurysm neck. When this pivoting valve is in its openconfiguration, embolic members (such as embolic coils, hydrogels,microsponges, beads, or string-of-pearls embolic strands) or liquidembolic material (which solidifies in the aneurysm) can be insertedthrough the opening in the mesh into an aneurysm. This type of pivotingvalve is more appropriate for liquid embolic material than for coils,beads, or string-of-pearls strands which might get snagged on it. Whenthis pivoting valve is in its closed configuration, it reduces bloodflood through the opening in the mesh into the aneurysm. In other words,this pivoting valve can serve as a “closure mechanism” for anintrasacular aneurysm occlusion device. We all have times when we needclosure.

FIG. 38 shows two sequential views of a plug mechanism which can be usedin an intrasacular device for occluding a cerebral aneurysm. The lefthalf of FIG. 38 shows this plug mechanism at a first point in time, inits closed configuration. The right half of FIG. 38 shows this plugmechanism at a second point in time, in its open configuration.Specifically, the plug mechanism shown in FIG. 38 comprises a lumen(opening) 3801 and a plug 3802 which is inserted into the lumen. When aplug blocks the lumen (opening), then the plug mechanism is in itsclosed configuration. When a plug does not block the lumen (opening),then the plug mechanism is in its open configuration. In this example,the plug mechanism is changed from its open configuration to its closedconfiguration by inserting a plug into the lumen (opening). In anexample, a plug can be inserted remotely by the operator of the device,enabling the operator to close the plug mechanism remotely. In anexample, a plug can be inserted into a lumen by using a guidewire orhydraulic pressure. In an example, a plug can be made from hydrogel.

This plug mechanism is just one type of closure mechanism which can beused in any of in the intrasacular devices shown elsewhere in thisdisclosure or priority-linked disclosures. In an example, this plugmechanism can be positioned in an opening (or lumen) through a mesh (ornet) which bridges an aneurysm neck. When this plug mechanism is in itsopen configuration, embolic members (such as embolic coils, hydrogels,microsponges, beads, or string-of-pearls embolic strands) or liquidembolic material (which solidifies in the aneurysm) can be insertedthrough the opening in the mesh into an aneurysm. When this plugmechanism is in its closed configuration, it reduces blood flood throughthe opening in the mesh into the aneurysm.

In an example, a “string-of-pearls” embolic member can be a component ofan intrasacular aneurysm occlusion device. In an example, a“string-of-pearls” embolic member can be inserted into a flexible net ormesh within an aneurysm sac. Alternatively, a “string-of-pearls” embolicmember alone can be directly inserted into an aneurysm sac. A“string-of-pearls” embolic member can be defined as a longitudinalseries of bead-like embolic “pearls” (e.g. not actual pearls, but ratherbead-like embolic masses) which are connected by a flexible longitudinal“string” (e.g. a flexible strand, thread, filament, suture, tube, orwire).

In an example, pearls in a string-of-pearls embolic member can beconvex. In an example, pearls can be globular, spherical, and/orellipsoidal. In an example, pearls can be polyhedral. In an example,pearls in a string-of-pearls embolic member can be concave. In anexample, pearls can be beads. In an example, pearls can be hard. In anexample, pearls can have a durometer level greater than 50. In anexample, pearls can be soft. In an example, pearls can have a durometerlevel less than 20. In an example, pearls can have a durometer levelless than 10. In an example, pearls can be compressed while travelingthrough a catheter and can expand after insertion into an aneurysm. Inan example, pearls can expand between 100% and 400% upon their insertioninto an aneurysm. In an example, pearls can have a first average sizewhile they travel through a catheter and a second average size afterexpansion in an aneurysm sac, wherein the second average size is between2-5 times the first average size. In an example, pearls can bemicrosponges or gels. In an example, pearls can be hydrogels.

In an example, a string in a string-of-pearls embolic member can be aflexible polymer strand, thread, suture, or filament. In an example, astring can be a flexible metal wire, tube, or filament. In an example, astring can be an organic thread or yarn. In an example, a longitudinalseries of pearls can be centrally connected by a string. In an example,a longitudinal series of pearls can be connected by two or more strings.In an example, a string in a string-of-pearls embolic member can beundulating and/or sinusoidal. In an example, a string in astring-of-pearls embolic member can be helical. In an example, a stringin a string-of-pearls embolic member can be a helical wire and/or coil.

In an example, pearls in a string-of-pearls embolic member can be(pair-wise) equidistant from each other. In an example, astring-of-pearls embolic member can comprise an equidistant longitudinalseries of pearls connected by a string. In an example, pearls in adistal portion of a string-of-pearls can be closer together than pearlsin a proximal portion of the string-of-pearls, wherein the distalportion is first inserted into the aneurysm sac. In an example, pearlsin a distal portion of a string-of-pearls can be a first averagedistance apart and pearls in a proximal portion of the string-of-pearlscan be second distance apart, wherein the second distance is greaterthan the first distance. In an example, pearls in a distal portion of astring-of-pearls can be farther apart than pearls in a proximal portionof the string-of-pearls, wherein the distal portion is first insertedinto the aneurysm sac. In an example, pearls in a distal portion of astring-of-pearls can be a first average distance apart and pearls in aproximal portion of the string-of-pearls can be second distance apart,wherein the second distance is less than the first distance. In anexample, the average length of string segments connecting pairs ofpearls in a string-of-pearls embolic member can be between 1 and 10times the average size (e.g. diameter) of the pearls.

In an example, pearls in a string-of-pearls embolic member can all bethe same size (e.g. diameter). In an example, pearls in a distal portionof a string-of-pearls can be larger than pearls in a proximal portion ofa string-of-pearls, wherein the distal portion is first inserted intothe aneurysm sac. In an example, pearls in a distal portion of astring-of-pearls can be have a first average size (e.g. diameter) andpearls in a proximal portion of the string-of-pearls can have a secondaverage size (e.g. diameter), wherein the second average size is lessthan the first average size. In an example, pearls in a distal portionof a string-of-pearls can be smaller than pearls in a proximal portionof a string-of-pearls, wherein the distal portion is first inserted intothe aneurysm sac. In an example, pearls in a distal portion of astring-of-pearls can be have a first average size (e.g. diameter) andpearls in a proximal portion of the string-of-pearls can have a secondaverage size (e.g. diameter), wherein the second average size is greaterthan the first average size.

In an example, pearls in a string-of-pearls embolic member can all havethe same durometer level. In an example, pearls in a distal portion of astring-of-pearls can have a higher durometer level than pearls in aproximal portion of a string-of-pearls, wherein the distal portion isfirst inserted into the aneurysm sac. In an example, pearls in a distalportion of a string-of-pearls can be have a first durometer level andpearls in a proximal portion of the string-of-pearls can have a seconddurometer level, wherein the second durometer level is less than thefirst durometer level. In an example, pearls in a distal portion of astring-of-pearls can have a lower durometer level than pearls in aproximal portion of a string-of-pearls, wherein the distal portion isfirst inserted into the aneurysm sac. In an example, pearls in a distalportion of a string-of-pearls can be have a first durometer level andpearls in a proximal portion of the string-of-pearls can have a seconddurometer level, wherein the second durometer level is greater than thefirst durometer level.

In an example, pearls in a string-of-pearls embolic member can have anaverage size which is greater than the average size of openings in aflexible net or mesh into which the pearls are inserted. In an example,pearls in a string-of-pearls embolic member can have an average sizewhich is between 1 and 5 times the average size of openings in aflexible net or mesh. In an example, the average length of stringsegments connecting pearls in a string-of-pearls embolic member can bebetween 1 and 10 times the average size of pearls in a string-of-pearlsembolic member. In an example, the average length of string segmentsconnecting pearls in a string-of-pearls embolic member can be between 1and 10 times the average size of openings in a flexible net or mesh. Inan example, a string in a string-of-pearls embolic member can be madefrom twine and the pearls can be flow into the sac before the string.However, it is probably not a good idea to flow pearls before twine.

In an example, a string-of-pearls embolic member can be deliveredthrough a catheter by means of a liquid flow and/or fluid pressure. Inan example, a string-of-pearls embolic member can be delivered through acatheter by means of a guide wire and/or pusher wire. In an example, astring-of-pearls embolic member can be delivered through a catheter bymeans of a conveyor belt mechanism which engages and moves the “pearl”components. In an example, a series of pre-formed separatestring-of-pearls embolic members can be sequentially inserted into ananeurysm. In an example, the length of a string-of-pearls embolic membercan be selected by a device operator during deployment by a cuttingand/or detaching mechanism which the operator uses to cut and/or detachthe string-of-pearls embolic member at a selected location duringdeployment into an aneurysm.

In an example, a volume-measuring mechanism can track the cumulativevolume of a string-of-pearls embolic member as it is progressivelyinserted into an aneurysm sac. In an example, this cumulative volume canbe compared to an estimated volume of the aneurysm sac based on priormedical imaging. In an example, the three-dimensional volume of ananeurysm sac can be estimated based on three-dimensional medical imagingand the cumulative volume of a string-of-pearls embolic member which isinserted in the aneurysm sac can be based on this three-dimensionalvolume of the aneurysm sac. In an example, a string-of-pearls embolicmember can be progressively inserted into an aneurysm sac until thecumulative volume of the string-of-pearls embolic member which has beeninserted into the sac is at least 60% of the estimated volume of theaneurysm sac. In an example, a string-of-pearls embolic member can beprogressively inserted into an aneurysm sac until the cumulative volumeof the string-of-pearls embolic member which has been inserted into thesac is at least 80% of the estimated volume of the aneurysm sac. In anexample, a string-of-pearls embolic member can be progressively insertedinto an aneurysm sac until the cumulative volume of the string-of-pearlsembolic member which has been inserted into the sac is between 60% and95% of the estimated volume of the aneurysm sac.

FIG. 39 shows an example of a “string-of-pearls” embolic member. This“string-of-pearls” embolic member can be used in one of the aneurysmocclusion devices which is discussed elsewhere in this disclosure orpriority-linked disclosures. Specifically, FIG. 39 shows astring-of-pearls embolic member comprising: a longitudinal series ofembolic pearls (e.g. bead-like polymer, hydrogel, or metal masses)including 3901, wherein the embolic pearls are connected to each otherin a series by a flexible longitudinal string (e.g. a flexible strand,thread, filament, tube, or wire) 3902, and wherein pearls in thelongitudinal series are pair-wise equidistant from each other.

FIG. 40 shows an example of a “string-of-pearls” embolic member. This“string-of-pearls” embolic member can be used in one of the aneurysmocclusion devices which is discussed elsewhere in this disclosure orpriority-linked disclosures. Specifically, FIG. 40 shows astring-of-pearls embolic member comprising: a longitudinal series ofembolic pearls (e.g. bead-like polymer, hydrogel, or metal masses)including 4001, wherein the embolic pearls are connected to each otherin a series by a flexible longitudinal string (e.g. a flexible strand,thread, filament, tube, or wire) 4002, wherein pearls in a distalportion of the longitudinal series are a first average distance fromeach other, wherein pearls in a proximal portion of the longitudinalseries are a second average distance from each other, and wherein thesecond average distance is less than the first average distance.

FIG. 41 shows an example of a “string-of-pearls” embolic member. This“string-of-pearls” embolic member can be used in one of the aneurysmocclusion devices which is discussed elsewhere in this disclosure orpriority-linked disclosures. Specifically, FIG. 41 shows astring-of-pearls embolic member comprising: a longitudinal series ofembolic pearls (e.g. bead-like polymer, hydrogel, or metal masses)including 4101, wherein the embolic pearls are connected to each otherin a series by a flexible longitudinal string (e.g. a flexible strand,thread, filament, tube, or wire) 4102, wherein pearls in a distalportion of the longitudinal series are a first average size, whereinpearls in a proximal portion of the longitudinal series are a secondaverage size, and wherein the second average size is less than the firstaverage size.

FIG. 42 shows an example of a “string-of-pearls” embolic member. This“string-of-pearls” embolic member can be used in one of the aneurysmocclusion devices which is discussed elsewhere in this disclosure orpriority-linked disclosures. Specifically, FIG. 42 shows astring-of-pearls embolic member comprising: a longitudinal series ofembolic pearls (e.g. bead-like polymer, hydrogel, or metal masses)including 4201, wherein the embolic pearls are connected to each otherin a series by a flexible longitudinal string (e.g. a flexible strand,thread, filament, tube, or wire) 4202, wherein the flexible longitudinalstring is undulating, sinusoidal, or helical.

FIG. 43 shows an example of a “string-of-pearls” embolic member. This“string-of-pearls” embolic member can be used in one of the aneurysmocclusion devices which is discussed elsewhere in this disclosure orpriority-linked disclosures. Specifically, FIG. 43 shows astring-of-pearls embolic member comprising: a longitudinal series ofsoft, compressible embolic pearls including 4301, wherein the embolicpearls are connected to each other in a series by a flexiblelongitudinal string (e.g. a flexible strand, thread, filament, tube, orwire) 4302.

FIG. 44 shows an example of a “string-of-pearls” embolic member. This“string-of-pearls” embolic member can be used in one of the aneurysmocclusion devices which is discussed elsewhere in this disclosure orpriority-linked disclosures. Specifically, FIG. 44 shows astring-of-pearls embolic member comprising: a longitudinal series ofembolic pearls (e.g. bead-like polymer, hydrogel, or metal masses)including 4401, wherein the embolic pearls are connected to each otherin a series by two flexible longitudinal strings (e.g. a flexiblestrands, threads, filaments, tubes, or wires) including 4402.

FIG. 45 shows four sequential views of a device for occluding a cerebralaneurysm comprising: a globular (e.g. spherical or ellipsoidal) mesh4502 which is configured to be radially expanded in an aneurysm 4501,wherein there is a mesh wall opening 4503 in a proximal portion of thewall of the globular mesh; a stent 4504 which is configured to beradially expanded in a parent vessel of the aneurysm, wherein there is astent wall opening 4505 in the wall of the stent, and wherein the stentwall opening is aligned with the mesh wall opening; and an hourglassshaped (or hyperbolic, dumbbell, or peanut shaped) mesh 4506 which isinserted into the mesh wall and stent wall openings and thenlongitudinally-compressed (e.g. like a rivet) in order to attach theglobular mesh and the stent to each other.

The upper left quadrant of FIG. 45 shows this device at a first point intime wherein the globular mesh is being radially expanded within ananeurysm. The upper right quadrant of FIG. 45 shows this device at asecond point in time wherein the stent is being radially expanded withinthe parent vessel of the aneurysm. The lower left quadrant of FIG. 45shows this device at a third point in time wherein the hourglass shapedmesh is being inserted into the mesh wall and stent wall openings. Thelower right quadrant of FIG. 45 shows this device at a fourth point intime wherein the hourglass shaped mesh is being longitudinallycompressed in order to attach the globular mesh and the stent to eachother. In an variation on this example, the globular mesh and the stentcan be fused to each other by the application of electromagnetic energyinstead of by the compression of an hourglass mesh.

FIG. 46 shows four sequential views of a device for occluding a cerebralaneurysm comprising: a globular (e.g. spherical or ellipsoidal) mesh4602 which is configured to be radially expanded in an aneurysm 4601; awire (or filament, string, or thread) 4603 which is attached to a distalportion of the globular mesh; and a stent 4604 which is configured to beradially expanded in a parent vessel of the aneurysm, wherein the distalportion of the globular mesh is collapsed toward the proximal portion ofthe globular mesh when the wire is pulled. In a variation on thiswording, FIG. 46 also shows a device for occluding a cerebral aneurysmcomprising: a globular (e.g. spherical or ellipsoidal) mesh which isconfigured to be radially expanded in an aneurysm; a wire (or filament,string, or thread) which is attached to a distal portion of the globularmesh; and a stent which is configured to be radially expanded in aparent vessel of the aneurysm, wherein the distal portion of theglobular mesh is collapsed toward the stent when the wire is pulled.

The upper left quadrant of FIG. 46 shows this device at a first point intime wherein the globular mesh is being radially expanded within ananeurysm. The upper right quadrant of FIG. 46 shows this device at asecond point in time wherein the stent is being radially expanded withinthe parent vessel of the aneurysm. The lower left quadrant of FIG. 46shows this device at a third point in time wherein the wire is pullingthe distal portion of the globular mesh toward the proximal portion ofthe globular mesh (and also toward the stent). In an example, theglobular mesh can have a first (pre-collapse) configuration which isgenerally spherical or ellipsoidal and a second (post-collapse)configuration which is generally hemispherical and/or bowl-shaped. Thelower right quadrant of FIG. 45 shows this device at a fourth point intime after the wire has been detached and removed.

FIG. 47 shows two sequential cross-sectional views of a device foroccluding a cerebral aneurysm comprising: a longitudinal tubular mesh(e.g. a stent) 4701 which is configured to be inserted into the parentvessel of an aneurysm; a first inner mesh 4702 which is inside thecentral cavity of the longitudinal tubular mesh, which overlaps a firstportion (e.g. a first side) of the circumference of the longitudinaltubular mesh, and which is attached to the longitudinal tubular mesh byone or more connections 4704 and 4706; and a second inner mesh 4703which is inside the central cavity of the longitudinal tubular mesh,which overlaps a second portion (e.g. a second side) of thecircumference of the longitudinal tubular mesh, and which is attached tothe longitudinal tubular mesh by one or more connections 4705 and 4707.

In an example, the one or more connections between an inner mesh (e.g.either the first inner mesh or the second inner mesh) which is fartherfrom the aneurysm neck are detached and that inner mesh is removed afterthe device has been deployed in the parent vessel of an aneurysm. Thiscauses the side of the longitudinal tubular mesh which is closer to theaneurysm neck to have a lower porosity than the side of the longitudinaltubular mesh which is farther from the aneurysm neck. The left side ofFIG. 47 shows this device at a first point in time wherein both of theinner meshes are attached to the longitudinal tubular mesh. The rightside of FIG. 47 shows this device at a second point in time wherein oneof the inner meshes (e.g. the one farther from the aneurysm neck) hasbeen detached and removed. In this example, connections have been melted(e.g. detached) by the application of electromagnetic energy.

FIG. 48 shows two sequential cross-sectional views of a device foroccluding a cerebral aneurysm comprising: a longitudinal tubular mesh(e.g. a stent) 4801 which is configured to be inserted into the parentvessel of an aneurysm; a first inner mesh 4802 which is inside thecentral cavity of the longitudinal tubular mesh, wherein the first innermesh has a first configuration which overlaps a first portion (e.g. afirst side) of the circumference of the longitudinal tubular mesh,wherein the first inner mesh can have a second configuration whichoverlaps a second portion (e.g. a second side) of the circumference ofthe longitudinal tubular mesh, wherein the first inner mesh is inelectromagnetic communication with one or more electrodes 4804 and 4806,and wherein application electromagnetic energy to first inner meshcauses it to change from the first configuration to the secondconfiguration; and a second inner mesh 4803 which is inside the centralcavity of the longitudinal tubular mesh, wherein the second inner meshhas a third configuration which overlaps the second portion (e.g. thesecond side) of the circumference of the longitudinal tubular mesh,wherein the second inner mesh can have a fourth configuration whichoverlaps the first portion (e.g. the first side) of the circumference ofthe longitudinal tubular mesh, wherein the second inner mesh is inelectromagnetic communication with one or more electrodes 4805 and 4807,wherein application electromagnetic energy to the second inner meshcauses it to change from the third configuration to the fourthconfiguration.

In an example, the configuration of an inner mesh (e.g. either the firstinner mesh or the second inner mesh) which is farther from the aneurysmneck is changed after the device has been deployed in the parent vesselof an aneurysm. This causes the side of the longitudinal tubular meshwhich is closer to the aneurysm neck to have a lower porosity than theside of the longitudinal tubular mesh which is farther from the aneurysmneck. The left side of FIG. 48 shows this device at a first point intime before the configuration of one of the inner meshes has beenchanged. The right side of FIG. 48 shows this device at a second pointin time after the configuration of one of the inner meshes has beenchanged by application of electromagnetic energy to electrodes. In thisexample, application of electromagnetic energy causes the curvature ofan inner mesh to change direction (e.g. from convex to concave), therebychanging which side of the longitudinal tubular mesh it overlaps. In anexample, a first inner mesh and/or a second inner mesh can be made fromshape memory material whose curvature changes when exposed toelectromagnetic energy.

FIG. 49 shows two sequential cross-sectional views of a device foroccluding a cerebral aneurysm comprising: a longitudinal tubular mesh(e.g. a stent) 4901 which is configured to be inserted into the parentvessel of an aneurysm; a first inner mesh 4902 which is inside thecentral cavity of the longitudinal tubular mesh, wherein the first innermesh has a first configuration which overlaps a first portion (e.g. afirst side) of the circumference of the longitudinal tubular mesh,wherein the first inner mesh has a second configuration which overlaps asecond portion (e.g. a second side) of the circumference of thelongitudinal tubular mesh, wherein the first inner mesh in its firstconfiguration is attached to the longitudinal tubular mesh by connection4904, wherein the first inner mesh is predisposed (e.g. biased) towardthe second configuration but is held in the first configuration byconnection 4904, wherein detachment of connection 4904 releases thefirst inner mesh from the first configuration to the secondconfiguration; and a second inner mesh 4903 which is inside the centralcavity of the longitudinal tubular mesh, wherein the second inner meshhas a third configuration which overlaps the second portion (e.g. thesecond side) of the circumference of the longitudinal tubular mesh,wherein the second inner mesh has a fourth configuration which overlapsthe first portion (e.g. the first side) of the circumference of thelongitudinal tubular mesh, wherein the second inner mesh in its thirdconfiguration is attached to the longitudinal tubular mesh by connection4905, wherein the second inner mesh is predisposed (e.g. biased) towardthe fourth configuration but is held in the third configuration byconnection 4905, wherein detachment of connection 4905 releases thesecond inner mesh from the third configuration to the fourthconfiguration.

In an example, the configuration of an inner mesh (e.g. either the firstinner mesh or the second inner mesh) which is farther from the aneurysmneck is changed after the device has been deployed in the parent vesselof an aneurysm. This causes the side of the longitudinal tubular meshwhich is closer to the aneurysm neck to have a lower porosity than theside of the longitudinal tubular mesh which is farther from the aneurysmneck. The left side of FIG. 49 shows this device at a first point intime before the configuration of one of the inner meshes has beenchanged. The right side of FIG. 49 shows this device at a second pointin time after the configuration of one of the inner meshes has beenchanged by detachment of a connection. In this example, detachment isdone by applying electromagnetic energy to a connection.

FIG. 50 shows three sequential longitudinal views of a device foroccluding a cerebral aneurysm comprising: a longitudinal tubular mesh(e.g. a stent) 5003 with a spiral cross-sectional perimeter, wherein thelongitudinal tubular mesh is configured to be inserted into a bloodvessel that includes an aneurysm sac 5001 and an entrance to a branchingblood vessel 5002, wherein a first portion of the circumference of thelongitudinal tubular mesh is configured to face the aneurysm sac, andwherein a second portion of the circumference of the longitudinaltubular mesh is configured to face the entrance to the branching bloodvessel; and a plurality of detachable connections, including connections5004 and 5005, which hold longitudinal segments of the longitudinaltubular mesh together, wherein a selected subset of the detachableconnections are detached after the device has been deployed in the bloodvessel, wherein this detachment separates a subset of the longitudinalsegments which are along the second portion of the circumference of thelongitudinal tubular mesh from the rest of the longitudinal tubularmesh, wherein the subset of longitudinal segments are removed from restof the longitudinal tubular mesh, and wherein this removal oflongitudinal segments causes the longitudinal tubular mesh to havegreater porosity along the second portion of its circumference thanalong the first portion of its circumference.

The upper third of FIG. 50 shows this device at a first point in timeafter the longitudinal tubular mesh has been inserted into the bloodvessel, but before a selected subset of connections has been detached.

The middle third of FIG. 50 shows this device at a second point in timeafter the selected subset of connections have been detached, but beforea selected subset of longitudinal segments (along the entrance to thebranching blood vessel) has been removed. The lower third of FIG. 50shows this device at a third point in time after the selected subset oflongitudinal segments (along the entrance to the branching blood vessel)has been removed, resulting in a stent with greater porosity along theentrance to the branching blood vessel and lower porosity along theaneurysm neck. In an example, detachment of a subset of connections canbe done by applying electromagnetic energy to them (e.g. melting them).

FIG. 51 shows three sequential views of a device for occluding acerebral aneurysm comprising: a distal tubular mesh 5102, wherein thedistal end of the distal tubular mesh is pinched and inverted, andwherein the distal tubular mesh is configured to be inserted into andexpanded within an aneurysm 5101 at a first distance from the aneurysmneck; a proximal tubular mesh 5103, wherein the distal end of theproximal tubular mesh is pinched and inverted, and wherein the proximaltubular mesh is configured to be inserted into and expanded within theaneurysm at a second distance from the aneurysm neck, wherein the seconddistance is less than the first distance, wherein the distal tubularmesh and the proximal tubular mesh have a first configuration duringtheir delivery to the aneurysm in which they are not nested, and whereinthe distal tubular mesh and the proximal tubular mesh have a secondconfiguration after expansion within the aneurysm in which they arenested; and a longitudinal member (e.g. wire, string, or filament) whichconnects the distal tubular mesh and the proximal tubular mesh while themeshes are being delivered to the aneurysm.

The upper third of FIG. 51 shows this device at a first point in timebefore the distal tubular mesh and the proximal tubular mesh have beeninserted into and expanded within an aneurysm sac. At this first pointin time, the distal tubular mesh and the proximal tubular mesh are notin a nested configuration. The middle third of FIG. 51 shows this deviceat a second point in time after the distal tubular mesh has beenpartially expanded within the aneurysm sac and before the proximaltubular mesh has been expanded within the aneurysm sac. The lower thirdof FIG. 51 shows this device at a third point in time after both thedistal tubular mesh and the proximal tubular mesh have been insertedinto and expanded within the aneurysm sac. At this third point in time,the distal tubular mesh and the proximal tubular mesh are in a nestedconfiguration.

In an example, a proximal tubular mesh can have a smaller diameter thana distal tubular mesh. In an example, a proximal tubular mesh can benested within the concavity of a distal tubular mesh in their secondconfiguration. In an example, a distal tubular mesh can have a smallerdiameter than a proximal tubular mesh. In an example, a distal tubularmesh can be nested within the concavity of a tubular mesh in theirsecond configuration. In an example, the proximal diameter of a distaltubular mesh can be larger than the diameter of an aneurysm neck. In anexample, the proximal diameter of a proximal tubular mesh can be largerthan the diameter of an aneurysm neck.

In an example, distal and proximal tubular meshes can be coaxial intheir second configuration. In an example, the longitudinal axes ofdistal and proximal tubular meshes can be coaxial in their secondconfiguration. In an example, distal and proximal tubular meshes canhave a first degree of overlap in their first configuration and a seconddegree of overlap in their second configuration, wherein the seconddegree is greater than the first degree. In an example, distal andproximal tubular meshes do not overlap in their first configuration, butdo overlap in their second configuration. In an example, the distal endsof the distal and proximal tubular meshes can be pinched and inverted.In an example, the distal ends of the distal and proximal tubular meshescan be pinched and partially inverted. Alternatively, the distal ends ofthe distal and proximal tubular meshes can be pinched, but not inverted.

In an example, distal and proximal tubular meshes can be changed fromtheir first configuration to their second configuration by pulling (orpushing) a longitudinal member (e.g. wire, string, or filament) whichconnects the meshes. In an example, a device operator can change distaland proximal tubular meshes from their first configuration to theirsecond configuration by pulling (or pushing) a longitudinal member (e.g.wire, string, or filament) which connects the meshes. In an example,this device can be deployed in the following sequence: first, the distaltubular mesh is inserted into and expanded within an aneurysm sac; andsecond, the proximal tubular mesh is inserted into and expanded withinthe distal tubular mesh. In an example, a longitudinal member whichconnects the distal and proximal tubular meshes can then be detached andremoved.

In an example, a device for occluding a cerebral aneurysm comprising: adistal hemispherical mesh, wherein the distal hemispherical mesh isconfigured to be inserted into and expanded within an aneurysm at afirst distance from the aneurysm neck; a proximal hemispherical mesh,wherein the proximal hemispherical mesh is configured to be insertedinto and expanded within the aneurysm at a second distance from theaneurysm neck, wherein the second distance is less than the firstdistance, wherein the distal hemispherical mesh and the proximalhemispherical mesh have a first configuration during their delivery tothe aneurysm in which they are not nested, and wherein the distalhemispherical mesh and the proximal hemispherical mesh have a secondconfiguration after expansion within the aneurysm in which they arenested; and a longitudinal member (e.g. wire, string, or filament) whichconnects the distal hemispherical mesh and the proximal hemisphericalmesh while the meshes are being delivered to the aneurysm.

In an example, a device for occluding a cerebral aneurysm comprising: adistal convex mesh, wherein the distal convex mesh is configured to beinserted into and expanded within an aneurysm at a first distance fromthe aneurysm neck; a proximal convex mesh, wherein the proximal convexmesh is configured to be inserted into and expanded within the aneurysmat a second distance from the aneurysm neck, wherein the second distanceis less than the first distance, wherein the distal convex mesh and theproximal convex mesh have a first configuration during their delivery tothe aneurysm in which they are not nested, and wherein the distal convexmesh and the proximal convex mesh have a second configuration afterexpansion within the aneurysm in which they are nested; and alongitudinal member (e.g. wire, string, or filament) which connects thedistal convex mesh and the proximal convex mesh while the meshes arebeing delivered to the aneurysm.

FIG. 52 shows three sequential views of a device for occluding acerebral aneurysm comprising: a distal tubular mesh 5202, wherein thedistal end of the distal tubular mesh is pinched and inverted, andwherein the distal tubular mesh is configured to be inserted into andexpanded within an aneurysm 5201 at a first distance from the aneurysmneck; a proximal tubular mesh 5203, wherein the proximal end of theproximal tubular mesh is pinched and inverted, and wherein the proximaltubular mesh is configured to be inserted into and expanded within theaneurysm at a second distance from the aneurysm neck, wherein the seconddistance is less than the first distance, wherein the distal tubularmesh and the proximal tubular mesh have a first configuration duringtheir delivery to the aneurysm in which they do not overlap, and whereinthe distal tubular mesh and the proximal tubular mesh have a secondconfiguration after expansion within the aneurysm in which they overlap;and a longitudinal member (e.g. wire, string, or filament) whichconnects the distal tubular mesh and the proximal tubular mesh while themeshes are being delivered to the aneurysm.

The upper third of FIG. 52 shows this device at a first point in timebefore the distal tubular mesh and the proximal tubular mesh have beeninserted into and expanded within an aneurysm sac. At this first pointin time, the distal tubular mesh and the proximal tubular mesh do notoverlap. The middle third of FIG. 52 shows this device at a second pointin time after the distal tubular mesh has been partially expanded withinthe aneurysm sac and before the proximal tubular mesh has been expandedwithin the aneurysm sac. The lower third of FIG. 52 shows this device ata third point in time after both the distal tubular mesh and theproximal tubular mesh have been inserted into and expanded within theaneurysm. At this third point in time, the distal tubular mesh and theproximal tubular mesh overlap.

In an example, a proximal tubular mesh can have a smaller diameter thana distal tubular mesh. In an example, a proximal tubular mesh can fitinto the concavity of a distal tubular mesh in their secondconfiguration. In an example, a distal tubular mesh can have a smallerdiameter than a proximal tubular mesh. In an example, a distal tubularmesh can fit into the concavity of a tubular mesh in their secondconfiguration. In an example, the proximal diameter of a distal tubularmesh can be larger than the diameter of an aneurysm neck. In an example,the distal diameter of a proximal tubular mesh can be larger than thediameter of an aneurysm neck.

In an example, distal and proximal tubular meshes can have a firstdegree of overlap in their first configuration and a second degree ofoverlap in their second configuration, wherein the second degree isgreater than the first degree. In an example, distal and proximaltubular meshes do not overlap in their first configuration, but dooverlap in their second configuration. In an example, the distal end ofthe distal tubular mesh and the proximal end of the proximal tubularmesh can be pinched and inverted. In an example, the distal end of thedistal tubular mesh and the proximal end of the proximal tubular meshcan be pinched and partially inverted. Alternatively, ends of the distaland proximal tubular meshes can be pinched, but not inverted.

In an example, distal and proximal tubular meshes can be changed fromtheir first configuration to their second configuration by pulling (orpushing) the longitudinal member (e.g. wire, string, or filament) whichconnects the meshes. In an example, a device operator can change thedistal and proximal tubular meshes from their first configuration totheir second configuration by pulling (or pushing) a longitudinal member(e.g. wire, string, or filament) which connects the meshes. In anexample, this device can be deployed in the following sequence: first,the distal tubular mesh is inserted into and expanded within an aneurysmsac; and second, the proximal tubular mesh is inserted into and expandedwithin the distal tubular mesh. In an example, a longitudinal memberwhich connects the distal and proximal tubular meshes can then bedetached and removed.

In an example, a device for occluding a cerebral aneurysm comprising: adistal hemispherical mesh which opens in a proximal direction, whereinthe distal hemispherical mesh is configured to be inserted into andexpanded within an aneurysm at a first distance from the aneurysm neck;a proximal hemispherical mesh which opens in a distal direction, whereinthe proximal hemispherical mesh is configured to be inserted into andexpanded within the aneurysm at a second distance from the aneurysmneck, wherein the second distance is less than the first distance,wherein the distal hemispherical mesh and the proximal hemisphericalmesh have a first configuration during their delivery to the aneurysm inwhich they do not overlap, and wherein the distal hemispherical mesh andthe proximal hemispherical mesh have a second configuration afterexpansion within the aneurysm in which they overlap; and a longitudinalmember (e.g. wire, string, or filament) which connects the distalhemispherical mesh and the proximal hemispherical mesh while the meshesare being delivered to the aneurysm. In an example, the distal andproximal hemispherical meshes can combine to form a spherical ortoroidal mesh in their second configuration.

In an example, a device for occluding a cerebral aneurysm comprising: adistal convex mesh which opens in a proximal direction, wherein thedistal convex mesh is configured to be inserted into and expanded withinan aneurysm at a first distance from the aneurysm neck; a proximalconvex mesh which opens in a distal direction, wherein the proximalconvex mesh is configured to be inserted into and expanded within theaneurysm at a second distance from the aneurysm neck, wherein the seconddistance is less than the first distance, wherein the distal convex meshand the proximal convex mesh have a first configuration during theirdelivery to the aneurysm in which they do not overlap, and wherein thedistal convex mesh and the proximal convex mesh have a secondconfiguration after expansion within the aneurysm in which they overlap;and a longitudinal member (e.g. wire, string, or filament) whichconnects the distal convex mesh and the proximal convex mesh while themeshes are being delivered to the aneurysm. In an example, the distaland proximal hemispherical meshes can combine to form an ellipsoidal ortoroidal mesh in their second configuration.

FIG. 54 shows three sequential views of a device for occluding acerebral aneurysm comprising: a helical wire 5402 which is configured tobe inserted into an aneurysm sac 5401, wherein the maximum diameter ofthe helical structure of the wire is larger than the diameter of theaneurysm neck; and a longitudinal plurality of sliding embolic masses5403 (e.g. compressible balls, soft polyhedrons, microsponges,hydrogels, longitudinal meshes, longitudinal ribbons, or soft coils)which can slide along the length of the helical wire, wherein thesliding embolic masses are slid (e.g. pushed) along the length of thehelical wire into the aneurysm sac after the helical wire has beeninserted into the aneurysm sac, and wherein accumulation of the slidingembolic masses within the aneurysm sac reduces and/or prevents bloodflow into the aneurysm sac.

The upper third of FIG. 54 shows this device at a first point in timeafter a helical wire has been inserted into an aneurysm sac, but beforethe plurality of sliding embolic masses have been slid along the helicalwire into the aneurysm sac. The middle third of FIG. 54 shows thisdevice at a second point in time as a plurality of sliding embolicmasses are being slid (e.g. pushed) along the length of the helical wireinto the aneurysm sac. The lower third of FIG. 54 shows this device at athird point in time after the plurality of sliding embolic masses haveaccumulated within the aneurysm sac and a proximal section of thehelical wire has been detached and removed.

In an example, sliding embolic members can be compressible balls. In anexample, sliding embolic members can be soft polyhedrons. In an example,the sliding embolic members can be microsponges. In an example, thesliding embolic members can be hydrogels. In an example, the slidingembolic members can be longitudinal mesh segments. In an example, thesliding embolic members can be longitudinal ribbon segments. In anexample, the sliding embolic members can be soft coils. In an example,the sliding embolic members can be beads. In an example, the slideembolic members have openings and/or holes through which the helicalwire goes. In an example, the slide embolic members have centralopenings and/or holes through which the helical wire goes. In anexample, the slide embolic members can be remotely slid and/or pushedalong the length of the helical wire by the device operator. In anexample, the helical structure of the helical wire can form a generallyglobular (e.g. spherical or ellipsoidal) shape.

FIG. 55 shows a cross-sectional view of a device for occluding acerebral aneurysm comprising: a bowl-shaped mesh 5502 which isconfigured to be inserted into and expanded within an aneurysm sac 5501so as to span the neck of the aneurysm from inside the aneurysm sac,wherein the bowl-shaped mesh is formed by pinching each of the distaland proximal ends of a tubular mesh and then moving these ends towardeach other; a distal lumen (e.g. cylinder, ring, band, tube, or torus)5503 within which the distal end of the tubular mesh is pinched and/orbound; a proximal lumen (e.g. cylinder, ring, band, tube, or torus) 5504within which the proximal end of the tubular mesh is pinched and/orbound; and one or more embolic members (e.g. coils, string-of-pearlsembolic strands, hydrogels, microsponges, or beads) 5505 which areinserted through the proximal lumen and through the distal lumen intothe aneurysm sac, wherein accumulation of the one or more embolicmembers in the aneurysm sac helps to occlude the aneurysm and to holdthe bowl-shaped mesh against the neck of the aneurysm.

In this example, the distal lumen protrudes from the bowl-shaped mesh ina distal direction and the proximal lumen protrudes from the bowl-shapedmesh in a proximal direction. In this example, the bowl-shaped mesh isdouble-layered. In this example, the concavity of the bowl-shaped meshopens in a distal direction. In an example, the distal and proximal endsof the tubular mesh can be moved toward each other and the bowl-shapedmesh can be formed before the device is deployed. In an example, thedistal and proximal ends of the tubular mesh can be moved toward eachother to form the bowl-shaped mesh after the device has been insertedinto and expanded within the aneurysm sac. In an example, the distal endof the tubular mesh can be inverted or partially inverted. In anexample, the proximal end of the tubular mesh can be inverted orpartially inverted.

In an example, this device can further comprise a closure mechanismwithin the proximal lumen, wherein this mechanism is closed afterembolic members have been inserted into the aneurysm sac. In an example,the device can further comprise a catheter through which embolic membersare transported into the aneurysm sac. In an example, this catheter canextend through the proximal and distal lumens. In an example, thisdevice can further comprise a flexible net, mesh, bag, or liner which isinserted into the aneurysm sac (before the bowl-shaped mesh) in order tocontain the embolic members. In an example, such a flexible net, mesh,bad, or liner can expand to fill between 80% and 100% of the aneurysmsac as it is filled with embolic members.

FIG. 56 shows a cross-sectional view of a device for occluding acerebral aneurysm comprising: a bowl-shaped mesh 5602 which isconfigured to be inserted into and expanded within an aneurysm sac 5601so as to span the neck of the aneurysm from inside the aneurysm sac,wherein the bowl-shaped mesh is formed by pinching each of the distaland proximal ends of a tubular mesh and then moving these ends towardeach other; a distal lumen (e.g. cylinder, ring, band, tube, or torus)5603 within which the distal end of the tubular mesh is pinched and/orbound; a proximal lumen (e.g. cylinder, ring, band, tube, or torus) 5604within which the proximal end of the tubular mesh is pinched and/orbound; and one or more embolic members (e.g. coils, string-of-pearlsembolic strands, hydrogels, microsponges, or beads) 5605 which areinserted through the proximal lumen and through the distal lumen intothe aneurysm sac, wherein accumulation of the one or more embolicmembers in the aneurysm sac helps to occlude the aneurysm and to holdthe bowl-shaped mesh against the neck of the aneurysm.

In this example, the distal lumen extends inward from surface of thebowl-shaped mesh in a proximal direction and the proximal lumen extendsoutward from the bowl-shaped mesh in a proximal direction. In thisexample, the bowl-shaped mesh is double-layered. In this example, theconcavity of the bowl-shaped mesh opens in a distal direction. In anexample, the distal and proximal ends of the tubular mesh can be movedtoward each other and the bowl-shaped mesh can be formed before thedevice is deployed. In an example, the distal and proximal ends of thetubular mesh can be moved toward each other to form the bowl-shaped meshafter the device has been inserted into and expanded within the aneurysmsac. In an example, the distal end of the tubular mesh can be invertedor partially inverted. In an example, the proximal end of the tubularmesh can be inverted or partially inverted.

In an example, this device can further comprise a closure mechanismwithin the proximal lumen, wherein this mechanism is closed afterembolic members have been inserted into the aneurysm sac. In an example,the device can further comprise a catheter through which embolic membersare transported into the aneurysm sac. In an example, this catheter canextend through the proximal and distal lumens. In an example, thisdevice can further comprise a flexible net, mesh, bag, or liner which isinserted into the aneurysm sac (before the bowl-shaped mesh) in order tocontain the embolic members. In an example, such a flexible net, mesh,bad, or liner can expand to fill between 80% and 100% of the aneurysmsac as it is filled with embolic members.

FIG. 57 shows a cross-sectional view of a device for occluding acerebral aneurysm comprising: a bowl-shaped mesh 5702 which isconfigured to be inserted into and expanded within an aneurysm sac 5701so as to span the neck of the aneurysm from inside the aneurysm sac,wherein the bowl-shaped mesh is formed by pinching each of the distaland proximal ends of a tubular mesh and then moving these ends towardeach other; a distal lumen (e.g. cylinder, ring, band, tube, or torus)5703 within which the distal end of the tubular mesh is pinched and/orbound; a proximal lumen (e.g. cylinder, ring, band, tube, or torus) 5704within which the proximal end of the tubular mesh is pinched and/orbound; and one or more embolic members (e.g. coils, string-of-pearlsembolic strands, hydrogels, microsponges, or beads) 5705 which areinserted through the proximal lumen and through the distal lumen intothe aneurysm sac, wherein accumulation of the one or more embolicmembers in the aneurysm sac helps to occlude the aneurysm and to holdthe bowl-shaped mesh against the neck of the aneurysm.

In this example, the distal lumen extends inward from surface of thebowl-shaped mesh in a proximal direction and the proximal lumen extendsinward from the surface of the bowl-shaped mesh in a distal direction.In this example, the bowl-shaped mesh is double-layered. In thisexample, the concavity of the bowl-shaped mesh opens in a distaldirection. In an example, the distal and proximal ends of the tubularmesh can be moved toward each other and the bowl-shaped mesh can beformed before the device is deployed. In an example, the distal andproximal ends of the tubular mesh can be moved toward each other to formthe bowl-shaped mesh after the device has been inserted into andexpanded within the aneurysm sac. In an example, the distal end of thetubular mesh can be inverted or partially inverted. In an example, theproximal end of the tubular mesh can be inverted or partially inverted.

In an example, this device can further comprise a closure mechanismwithin the proximal lumen, wherein this mechanism is closed afterembolic members have been inserted into the aneurysm sac. In an example,the device can further comprise a catheter through which embolic membersare transported into the aneurysm sac. In an example, this catheter canextend through the proximal and distal lumens. In an example, thisdevice can further comprise a flexible net, mesh, bag, or liner which isinserted into the aneurysm sac (before the bowl-shaped mesh) in order tocontain the embolic members. In an example, such a flexible net, mesh,bad, or liner can expand to fill between 80% and 100% of the aneurysmsac as it is filled with embolic members.

FIG. 58 shows a cross-sectional view of a device for occluding acerebral aneurysm comprising: a bowl-shaped mesh 5802 which isconfigured to be inserted into and expanded within an aneurysm sac 5801so as to span the neck of the aneurysm from inside the aneurysm sac,wherein the bowl-shaped mesh is formed by pinching each of the distaland proximal ends of a tubular mesh and then moving these ends towardeach other; a distal lumen (e.g. cylinder, ring, band, tube, or torus)5803 within which the distal end of the tubular mesh is pinched and/orbound; a proximal lumen (e.g. cylinder, ring, band, tube, or torus) 5804within which the proximal end of the tubular mesh is pinched and/orbound; and one or more embolic members (e.g. coils, string-of-pearlsembolic strands, hydrogels, microsponges, or beads) 5805 which areinserted through the proximal lumen and through the distal lumen intothe aneurysm sac, wherein accumulation of the one or more embolicmembers in the aneurysm sac helps to occlude the aneurysm and to holdthe bowl-shaped mesh against the neck of the aneurysm.

In this example, the distal lumen extends outward from surface of thebowl-shaped mesh in a distal direction and the proximal lumen extendsinward from the surface of the bowl-shaped mesh in a distal direction.In this example, the bowl-shaped mesh is double-layered. In thisexample, the concavity of the bowl-shaped mesh opens in a distaldirection. In an example, the distal and proximal ends of the tubularmesh can be moved toward each other and the bowl-shaped mesh can beformed before the device is deployed. In an example, the distal andproximal ends of the tubular mesh can be moved toward each other to formthe bowl-shaped mesh after the device has been inserted into andexpanded within the aneurysm sac. In an example, the distal end of thetubular mesh can be inverted or partially inverted. In an example, theproximal end of the tubular mesh can be inverted or partially inverted.

In an example, this device can further comprise a closure mechanismwithin the proximal lumen, wherein this mechanism is closed afterembolic members have been inserted into the aneurysm sac. In an example,the device can further comprise a catheter through which embolic membersare transported into the aneurysm sac. In an example, this catheter canextend through the proximal and distal lumens. In an example, thisdevice can further comprise a flexible net, mesh, bag, or liner which isinserted into the aneurysm sac (before the bowl-shaped mesh) in order tocontain the embolic members. In an example, such a flexible net, mesh,bad, or liner can expand to fill between 80% and 100% of the aneurysmsac as it is filled with embolic members.

FIG. 59 shows a cross-sectional view of a device for occluding acerebral aneurysm comprising: a bowl-shaped mesh 5902 which isconfigured to be inserted into and expanded within an aneurysm sac 5901so as to span the neck of the aneurysm from inside the aneurysm sac,wherein the bowl-shaped mesh is formed by pinching and/or bindingtogether the distal and proximal ends of a tubular mesh; a lumen (e.g.cylinder, ring, band, tube, or torus) 5903 within which the distal andproximal ends of the tubular mesh are pinched and/or bound; and one ormore embolic members (e.g. coils, string-of-pearls embolic strands,hydrogels, microsponges, or beads) 5904 which are inserted through thelumen into the aneurysm sac, wherein accumulation of the one or moreembolic members in the aneurysm sac helps to occlude the aneurysm and tohold the bowl-shaped mesh against the neck of the aneurysm.

In this example, the lumen extends outward from surface of thebowl-shaped mesh in a distal direction. In this example, the bowl-shapedmesh is double-layered. In this example, the concavity of thebowl-shaped mesh opens in a distal direction. In an example, the distaland proximal ends of the tubular mesh can be moved and bound togetherand the bowl-shaped mesh can be formed before the device is deployed. Inan example, the distal and proximal ends of the tubular mesh can bemoved and bound together to form the bowl-shaped mesh after the devicehas been inserted into and expanded within the aneurysm sac. In anexample, the distal end of the tubular mesh can be inverted or partiallyinverted. In an example, the proximal end of the tubular mesh can beinverted or partially inverted.

In an example, this device can further comprise a closure mechanismwithin the lumen, wherein this mechanism is closed after embolic membershave been inserted into the aneurysm sac. In an example, the device canfurther comprise a catheter through which embolic members aretransported into the aneurysm sac. In an example, this catheter canextend through the lumen. In an example, this device can furthercomprise a flexible net, mesh, bag, or liner which is inserted into theaneurysm sac (before the bowl-shaped mesh) in order to contain theembolic members. In an example, such a flexible net, mesh, bad, or linercan expand to fill between 80% and 100% of the aneurysm sac as it isfilled with embolic members.

FIG. 60 shows a cross-sectional view of a device for occluding acerebral aneurysm comprising: a bowl-shaped mesh 6002 which isconfigured to be inserted into and expanded within an aneurysm sac 6001so as to span the neck of the aneurysm from inside the aneurysm sac,wherein the bowl-shaped mesh is formed by pinching and/or bindingtogether the distal and proximal ends of a tubular mesh; a lumen (e.g.cylinder, ring, band, tube, or torus) 6003 within which the distal andproximal ends of the tubular mesh are pinched and/or bound; and one ormore embolic members (e.g. coils, string-of-pearls embolic strands,hydrogels, microsponges, or beads) 6004 which are inserted through thelumen into the aneurysm sac, wherein accumulation of the one or moreembolic members in the aneurysm sac helps to occlude the aneurysm and tohold the bowl-shaped mesh against the neck of the aneurysm.

In this example, the lumen extends outward from surface of thebowl-shaped mesh in a proximal direction. In this example, thebowl-shaped mesh is double-layered. In this example, the concavity ofthe bowl-shaped mesh opens in a distal direction. In an example, thedistal and proximal ends of the tubular mesh can be moved and boundtogether and the bowl-shaped mesh can be formed before the device isdeployed. In an example, the distal and proximal ends of the tubularmesh can be moved and bound together to form the bowl-shaped mesh afterthe device has been inserted into and expanded within the aneurysm sac.In an example, the distal end of the tubular mesh can be inverted orpartially inverted. In an example, the proximal end of the tubular meshcan be inverted or partially inverted.

In an example, this device can further comprise a closure mechanismwithin the lumen, wherein this mechanism is closed after embolic membershave been inserted into the aneurysm sac. In an example, the device canfurther comprise a catheter through which embolic members aretransported into the aneurysm sac. In an example, this catheter canextend through the lumen. In an example, this device can furthercomprise a flexible net, mesh, bag, or liner which is inserted into theaneurysm sac (before the bowl-shaped mesh) in order to contain theembolic members. In an example, such a flexible net, mesh, bad, or linercan expand to fill between 80% and 100% of the aneurysm sac as it isfilled with embolic members.

FIG. 61 shows an example of an aneurysm occlusion device comprising: apeanut or hourglass shaped mesh inserted into an aneurysm; wherein themesh further comprises a distal portion; wherein the distal portion hasa first thickness and a proximal portion which spans the aneurysm neck,and wherein the proximal portion has a second thickness which is greaterthan the first thickness. With respect to individual components, FIG. 61shows an example of an aneurysm occlusion device comprising: a peanut orhourglass shaped mesh inserted into an aneurysm 6101; wherein the meshfurther comprises a distal portion 6102; wherein the distal portion hasa first thickness and a proximal portion 6103 which spans the aneurysmneck, and wherein the proximal portion has a second thickness which isgreater than the first thickness.

In an example, distal and proximal portions of a peanut or hourglassshaped mesh can have different levels of flexibility, Flexural modulus,and/or bendability. For example, an aneurysm occlusion device cancomprise: a peanut or hourglass shaped mesh inserted into an aneurysm;wherein the mesh further comprises a distal portion with a first levelof flexibility, Flexural modulus, and/or bendability and a proximalportion which spans the aneurysm neck, and wherein the proximal portionhas a second level of flexibility, Flexural modulus, and/or bendabilitywhich is less than the first level. In an example, distal and proximalportions of a peanut or hourglass shaped mesh can have different levelsof axial compliance, compressibility, and/or stiffness. In an example,an aneurysm occlusion device can comprise: a peanut or hourglass shapedmesh inserted into an aneurysm; wherein the mesh further comprises adistal portion with a first level of axial compliance, compressibility,and/or stiffness and a proximal portion which spans the aneurysm neck,and wherein the proximal portion has a second level of axial compliance,compressibility, and/or stiffness.

FIG. 62 shows an example of an aneurysm occlusion device comprising: apeanut or hourglass shaped distal (wire and/or polymer) mesh insertedinto an aneurysm sac; wherein the distal mesh centroid is a firstdistance from the aneurysm neck; and a bowl shaped proximal meshinserted into the aneurysm sac; wherein the proximal mesh centroid is asecond distance from the aneurysm neck; wherein the second distance isless than the first distance; wherein the proximal mesh spans theaneurysm neck; and wherein the proximal mesh is connected to the distalmesh. With respect to individual components, FIG. 62 shows an example ofan aneurysm occlusion device comprising: a peanut or hourglass shapeddistal (wire and/or polymer) mesh 6202 inserted into an aneurysm sac6201; wherein the distal mesh centroid is a first distance from theaneurysm neck; and a bowl shaped proximal mesh 6203 inserted into theaneurysm sac; wherein the proximal mesh centroid is a second distancefrom the aneurysm neck; wherein the second distance is less than thefirst distance; wherein the proximal mesh spans the aneurysm neck; andwherein the proximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different thicknesses. In an example, an aneurysmocclusion device can comprise: a peanut or hourglass shaped distal (wireand/or polymer) mesh inserted into an aneurysm sac; wherein the distalmesh has a first thickness; wherein the distal mesh centroid is a firstdistance from the aneurysm neck; and a bowl shaped proximal mesh with asecond thickness which is inserted into the aneurysm sac; wherein thesecond thickness is greater than the first thickness; wherein theproximal mesh centroid is a second distance from the aneurysm neck;wherein the second distance is less than the first distance; wherein theproximal mesh spans the aneurysm neck; wherein a portion of the distalmesh is within the concavity of the proximal mesh; and wherein theproximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different porosity levels. In an example, an aneurysmocclusion device can comprise: a peanut or hourglass shaped distal meshinserted into an aneurysm sac; wherein the distal mesh has a firstporosity level; wherein the distal mesh centroid is a first distancefrom the aneurysm neck; and a bowl shaped proximal mesh inserted intothe aneurysm sac; wherein the proximal mesh has a second porosity levelwhich is less than the first level; wherein the proximal mesh centroidis a second distance from the aneurysm neck; wherein the second distanceis less than the first distance; wherein the proximal mesh spans theaneurysm neck; and wherein the proximal mesh is connected to the distalmesh. In an example, an aneurysm occlusion device can comprise: a peanutor hourglass shaped distal (wire and/or polymer) mesh inserted into ananeurysm sac; wherein the distal mesh has a first level of porosity;wherein the distal mesh centroid is a first distance from the aneurysmneck; and a bowl shaped proximal mesh inserted into the aneurysm sac;wherein the proximal mesh has a second level of porosity which is lessthan the first level; wherein the proximal mesh centroid is a seconddistance from the aneurysm neck; wherein the second distance is lessthan the first distance; wherein the proximal mesh spans the aneurysmneck; and wherein the proximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of elasticity. In an example, an aneurysmocclusion device can comprise: a peanut or hourglass shaped distal meshinserted into an aneurysm sac; wherein the distal mesh has a firstelasticity level; wherein the distal mesh centroid is a first distancefrom the aneurysm neck; and a bowl shaped proximal mesh inserted intothe aneurysm sac; wherein the proximal mesh has a second elasticitylevel which is less than the first elasticity level; wherein theproximal mesh centroid is a second distance from the aneurysm neck;wherein the second distance is less than the first distance; wherein theproximal mesh spans the aneurysm neck; and wherein the proximal mesh isconnected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of flexibility. In an example, ananeurysm occlusion device can comprise: a peanut or hourglass shapeddistal mesh inserted into an aneurysm sac; wherein the distal mesh has afirst flexibility level; wherein the distal mesh centroid is a firstdistance from the aneurysm neck; and a bowl shaped proximal meshinserted into the aneurysm sac; wherein the proximal mesh has a secondflexibility level which is less than the first level; wherein theproximal mesh centroid is a second distance from the aneurysm neck;wherein the second distance is less than the first distance; wherein theproximal mesh spans the aneurysm neck; wherein a portion of the distalmesh is within the concavity of the proximal mesh; and wherein theproximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of conformability, deformable,malleability, and/or plasticity. In an example, an aneurysm occlusiondevice can comprise: a peanut or hourglass shaped distal mesh insertedinto an aneurysm sac; wherein the distal mesh has a first level ofconformability, deformable, malleability, and/or plasticity; wherein thedistal mesh centroid is a first distance from the aneurysm neck; and abowl shaped proximal mesh inserted into the aneurysm sac; wherein theproximal mesh has a second level of conformability, deformable,malleability, and/or plasticity which is less than the first level;wherein the proximal mesh centroid is a second distance from theaneurysm neck; wherein the second distance is less than the firstdistance; wherein the proximal mesh spans the aneurysm neck; wherein aportion of the distal mesh is within the concavity of the proximal mesh;and wherein the proximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of radial compliance, compressibility,and/or stiffness. In an example, an aneurysm occlusion device cancomprise: a peanut or hourglass shaped distal mesh inserted into ananeurysm sac; wherein the distal mesh has a first level of radialcompliance, compressibility, and/or stiffness; wherein the distal meshcentroid is a first distance from the aneurysm neck; and a bowl shapedproximal mesh inserted into the aneurysm sac; wherein the proximal meshhas a second level of radial compliance, compressibility, and/orstiffness which is greater than the first level; wherein the proximalmesh centroid is a second distance from the aneurysm neck; wherein thesecond distance is less than the first distance; wherein the proximalmesh spans the aneurysm neck; and wherein the proximal mesh is connectedto the distal mesh. In an example, an aneurysm occlusion device cancomprise: a peanut or hourglass shaped distal mesh inserted into ananeurysm sac; wherein the distal mesh has a first stiffness level;wherein the distal mesh centroid is a first distance from the aneurysmneck; and a bowl shaped proximal mesh inserted into the aneurysm sac;wherein the proximal mesh has a second stiffness level which is greaterthan the first level; wherein the proximal mesh centroid is a seconddistance from the aneurysm neck; wherein the second distance is lessthan the first distance; wherein the proximal mesh spans the aneurysmneck; and wherein the proximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of axial compliance, compressibility,and/or stiffness. In an example, an aneurysm occlusion device cancomprise: a peanut or hourglass shaped distal (wire and/or polymer) meshinserted into an aneurysm; wherein the distal mesh has a first level ofaxial compliance, compressibility, and/or stiffness; wherein the distalmesh centroid is a first distance from the aneurysm neck; and a bowlshaped proximal mesh inserted into the aneurysm; wherein the proximalmesh has a second level of axial compliance, compressibility, and/orstiffness; wherein the proximal mesh centroid is a second distance fromthe aneurysm neck; wherein the second distance is less than the firstdistance; wherein the proximal mesh spans the aneurysm neck; wherein aportion of the distal mesh is within the concavity of the proximal mesh;and wherein the proximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of elasticity, modulus of elasticity,and/or Young's modulus. In an example, an aneurysm occlusion device cancomprise: a peanut or hourglass shaped distal (wire and/or polymer) meshinserted into an aneurysm sac; wherein the distal mesh has a first levelof elasticity, modulus of elasticity, and/or Young's modulus; whereinthe distal mesh centroid is a first distance from the aneurysm neck; anda bowl shaped proximal mesh inserted into the aneurysm sac; wherein theproximal mesh has a second level of elasticity, modulus of elasticity,and/or Young's modulus which is less than the first level; wherein theproximal mesh centroid is a second distance from the aneurysm neck;wherein the second distance is less than the first distance; wherein theproximal mesh spans the aneurysm neck; wherein a portion of the distalmesh is within the concavity ofthe proximal mesh; and wherein theproximal mesh is connected to the distal mesh. In an example, the peanutor hourglass shaped mesh and the bowl shaped mesh can have differentlevels of compliance and/or compressibility. In an example, an aneurysmocclusion device can comprise: a peanut or hourglass shaped distal (wireand/or polymer) mesh inserted into an aneurysm sac; wherein the distalmesh has a first level of compliance and/or compressibility; wherein thedistal mesh centroid is a first distance from the aneurysm neck; and abowl shaped proximal mesh inserted into the aneurysm sac; wherein theproximal mesh has a second level of compliance and/or compressibilitywhich is greater than the first level; wherein the proximal meshcentroid is a second distance from the aneurysm neck; wherein the seconddistance is less than the first distance; wherein the proximal meshspans the aneurysm neck; and wherein the proximal mesh is connected tothe distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of stretchabilty and/or ductility. In anexample, an aneurysm occlusion device can comprise: a peanut orhourglass shaped distal (wire and/or polymer) mesh inserted into ananeurysm sac; wherein the distal mesh has a first level of stretchabiltyand/or ductility; wherein the distal mesh centroid is a first distancefrom the aneurysm neck; and a bowl shaped proximal mesh inserted intothe aneurysm sac; wherein the proximal mesh has a second level ofstretchabilty and/or ductility which is less than the first level;wherein the proximal mesh centroid is a second distance from theaneurysm neck; wherein the second distance is less than the firstdistance; wherein the proximal mesh spans the aneurysm neck; and whereinthe proximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of tensile strength. In an example, ananeurysm occlusion device can comprise: a peanut or hourglass shapeddistal (wire and/or polymer) mesh inserted into an aneurysm sac; whereinthe distal mesh has a first level of tensile strength; wherein thedistal mesh centroid is a first distance from the aneurysm neck; and abowl shaped proximal mesh inserted into the aneurysm sac; wherein theproximal mesh has a second level of tensile strength which is greaterthan the first level; wherein the proximal mesh centroid is a seconddistance from the aneurysm neck; wherein the second distance is lessthan the first distance; wherein the proximal mesh spans the aneurysmneck; wherein a portion of the distal mesh is within the concavity ofthe proximal mesh; and wherein the proximal mesh is connected to thedistal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of flexibility, Flexural modulus, and/orbendability. In an example, an aneurysm occlusion device can comprise: apeanut or hourglass shaped distal (wire and/or polymer) mesh insertedinto an aneurysm sac; wherein the distal mesh has a first level offlexibility, Flexural modulus, and/or bendability; wherein the distalmesh centroid is a first distance from the aneurysm neck; and a bowlshaped proximal mesh inserted into the aneurysm sac; wherein theproximal mesh has a second level of flexibility, Flexural modulus,and/or bendability which is less than the first level; wherein theproximal mesh centroid is a second distance from the aneurysm neck;wherein the second distance is less than the first distance; wherein theproximal mesh spans the aneurysm neck; wherein a portion of the distalmesh is within the concavity of the proximal mesh; and wherein theproximal mesh is connected to the distal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of stiffness, rigidity, and/orresiliency. In an example, an aneurysm occlusion device can comprise: apeanut or hourglass shaped distal (wire and/or polymer) mesh insertedinto an aneurysm sac; wherein the distal mesh has a first level ofstiffness, rigidity, and/or resiliency; wherein the distal mesh centroidis a first distance from the aneurysm neck; and a bowl shaped proximalmesh inserted into the aneurysm sac; wherein the proximal mesh has asecond level of stiffness, rigidity, and/or resiliency which is greaterthan the first level; wherein the proximal mesh centroid is a seconddistance from the aneurysm neck; wherein the second distance is lessthan the first distance; wherein the proximal mesh spans the aneurysmneck; wherein a portion of the distal mesh is within the concavity ofthe proximal mesh; and wherein the proximal mesh is connected to thedistal mesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of softness, durometer, and/or hardness.In an example, an aneurysm occlusion device can comprise: a peanut orhourglass shaped distal mesh inserted into an aneurysm sac; wherein thedistal mesh has a first level of softness, durometer, and/or hardness;wherein the distal mesh centroid is a first distance from the aneurysmneck; and a bowl shaped proximal mesh inserted into the aneurysm sac;wherein the proximal mesh has a second level of softness, durometer,and/or hardness; wherein the proximal mesh centroid is a second distancefrom the aneurysm neck; wherein the second distance is less than thefirst distance; wherein the proximal mesh spans the aneurysm neck;wherein a portion of the distal mesh is within the concavity of theproximal mesh; and wherein the proximal mesh is connected to the distalmesh.

In an example, the peanut or hourglass shaped mesh and the bowl shapedmesh can have different levels of elasticity, flexibility, porosity,stiffness, or thickness. In an example, an aneurysm occlusion device cancomprise: a peanut or hourglass shaped distal mesh inserted into ananeurysm sac; wherein the distal mesh has a first level of elasticity,flexibility, porosity, stiffness, or thickness; wherein the distal meshcentroid is a first distance from the aneurysm neck; and a bowl shapedproximal mesh inserted into the aneurysm sac; wherein the proximal meshhas a second level of elasticity, flexibility, porosity, stiffness, orthickness; wherein the proximal mesh centroid is a second distance fromthe aneurysm neck; wherein the second distance is less than the firstdistance; wherein the proximal mesh spans the aneurysm neck; and whereinthe proximal mesh is connected to the distal mesh.

In an example, an aneurysm occlusion device can comprise: a peanut orhourglass shaped distal mesh inserted into an aneurysm; and a proximalmesh inserted into the aneurysm; wherein the proximal mesh ishemispherical, bowl shaped, dome shaped, inverted dome shaped, invertedumbrella shaped, parabolic, paraboloid shaped, prolate hemisphereshaped, reflected parabola shaped, semi-circular, and/or umbrellashaped; wherein the proximal mesh spans the aneurysm neck; wherein aportion ofthe distal mesh is within the concavity of the proximal mesh;and wherein the proximal mesh is connected to the distal mesh.

FIG. 63 shows an example of an aneurysm occlusion device comprising: adistal (wire and/or polymer) mesh inserted into an aneurysm sac; whereinthe distal mesh is convex; wherein the distal mesh centroid is a firstdistance from the aneurysm neck; and a proximal mesh inserted into theaneurysm sac; wherein the proximal mesh is concave; wherein the proximalmesh centroid is a second distance from the aneurysm neck; wherein thesecond distance is less than the first distance; wherein the proximalmesh spans the aneurysm neck; and wherein the proximal mesh isaxially-aligned with the distal mesh. With respect to individualcomponents, FIG. 63 shows an example of an aneurysm occlusion devicecomprising: a distal (wire and/or polymer) mesh 6302 inserted into ananeurysm sac 6301; wherein the distal mesh is convex; wherein the distalmesh centroid is a first distance from the aneurysm neck; and a proximalmesh 6303 inserted into the aneurysm sac; wherein the proximal mesh isconcave; wherein the proximal mesh centroid is a second distance fromthe aneurysm neck; wherein the second distance is less than the firstdistance; wherein the proximal mesh spans the aneurysm neck; and whereinthe proximal mesh is axially-aligned with the distal mesh.

FIG. 63 also shows an example of an aneurysm occlusion devicecomprising: a distal (wire and/or polymer) mesh inserted into ananeurysm sac; wherein the distal mesh is convex; wherein the distal meshcentroid is a first distance from the aneurysm neck; and a proximal meshinserted into the aneurysm sac; wherein the proximal mesh is concave;wherein the proximal mesh centroid is a second distance from theaneurysm neck; wherein the second distance is less than the firstdistance; wherein the proximal mesh spans the aneurysm neck; and whereinthe proximal mesh is axially-aligned with the distal mesh.

In an example: the convex distal mesh can be spherical; and the concaveproximal mesh can have a bowl shape and/or a paraboloid shape. In anexample, an aneurysm occlusion device can comprise: a generallyspherical (wire and/or polymer) mesh (or net or porous balloon) which isinserted into an aneurysm sac; wherein the generally spherical meshcentroid is a first distance from the aneurysm neck; and a bowl orparaboloid shaped (wire) mesh inserted into the aneurysm sac; whereinthe bowl or paraboloid shaped mesh centroid is a second distance fromthe aneurysm neck; wherein the second distance is less than the firstdistance; wherein the bowl or paraboloid shaped mesh spans the aneurysmneck; and wherein the bowl or paraboloid shaped mesh is within aproximal portion of the generally spherical mesh. In an example, ananeurysm occlusion device can comprise: a generally spherical (wireand/or polymer) mesh (or net or porous balloon) which is inserted intoan aneurysm sac; wherein the generally spherical mesh centroid is afirst distance from the aneurysm neck; and a bowl or paraboloid shaped(wire) mesh inserted into the aneurysm sac; wherein the bowl orparaboloid shaped mesh centroid is a second distance from the aneurysmneck; wherein the second distance is less than the first distance;wherein the bowl or paraboloid shaped mesh spans the aneurysm neck; andwherein the generally spherical mesh and the bowl or paraboloid shapedmesh are connected to each other.

In an example, an aneurysm occlusion device can comprise: agenerally-spherical distal mesh (or net or porous balloon) which isinserted into an aneurysm sac; and a proximal mesh inserted into theaneurysm sac; wherein the proximal mesh is bowl or paraboloid shapedwith a distal-facing concavity; wherein the proximal mesh spans theaneurysm neck. In an example, an aneurysm occlusion device can comprise:a generally spherical mesh (or net or porous balloon) which is insertedinto an aneurysm sac; wherein the generally spherical mesh centroid is afirst distance from the aneurysm neck; and a bowl or paraboloid shaped(wire) mesh inserted into the aneurysm sac; wherein the bowl orparaboloid shaped mesh centroid is a second distance from the aneurysmneck; wherein the second distance is less than the first distance;wherein the bowl or paraboloid shaped mesh spans the aneurysm neck; andwherein a portion of the generally spherical mesh is within theconcavity of bowl or paraboloid shaped mesh.

In an example, an aneurysm occlusion device can comprise: a generallyspherical mesh (or net or porous balloon) which is inserted into ananeurysm sac; wherein the generally spherical mesh centroid is a firstdistance from the aneurysm neck; and a bowl or paraboloid shaped (wire)mesh inserted into the aneurysm sac; wherein the bowl or paraboloidshaped mesh centroid is a second distance from the aneurysm neck;wherein the second distance is less than the first distance; wherein thebowl or paraboloid shaped mesh spans the aneurysm neck; wherein aportion of the generally spherical mesh is within the concavity of thebowl or paraboloid shaped mesh; and wherein the bowl or paraboloidshaped mesh is (centrally) connected to the generally spherical mesh.

In an example: the convex distal mesh can be ellipsoidal, egg shaped, orapple shaped; and the concave proximal mesh can have a bowl shape and/ora paraboloid shape. In an example, an aneurysm occlusion device cancomprise: a distal mesh inserted into an aneurysm sac; wherein thedistal mesh is generally ellipsoidal, egg shaped, or apple shaped; and aproximal mesh inserted into the aneurysm sac; wherein the proximal meshis bowl or paraboloid shaped with a distal-facing concavity; wherein theproximal mesh spans the aneurysm neck.

In an example, the convex distal mesh and the concave proximal mesh canhave different levels of elasticity. In an example, an aneurysmocclusion device can comprise: a distal mesh (or net or porous balloon)which is inserted into an aneurysm sac; wherein the distal mesh isgenerally ellipsoidal, egg shaped, or apple shaped; wherein the distalmesh has a first elasticity level; and a proximal mesh inserted into theaneurysm sac; wherein the proximal mesh is bowl or paraboloid shapedwith a distal-facing concavity; wherein the proximal mesh has a secondelasticity level which is less than the first elasticity level; whereinthe proximal mesh spans the aneurysm neck; and wherein a portion of thedistal mesh is within the concavity of the proximal mesh. In an example,an aneurysm occlusion device can comprise: a generally-spherical distalmesh (or net or porous balloon) which is inserted into an aneurysm sac;wherein the distal mesh has a first elasticity level; and a proximalmesh inserted into the aneurysm sac; wherein the proximal mesh is bowlor paraboloid shaped with a distal-facing concavity; wherein theproximal mesh has a second elasticity level which is less than the firstelasticity level; wherein the proximal mesh spans the aneurysm neck.

In an example, an aneurysm occlusion device can comprise: agenerally-spherical distal (wire and/or polymer) mesh (or net or porousballoon) which is inserted into an aneurysm sac; wherein the distal meshhas a first elasticity level; and a proximal mesh inserted into theaneurysm sac; wherein the proximal mesh is bowl or paraboloid shapedwith a distal-facing concavity; wherein the proximal mesh has a secondelasticity level which is less than the first elasticity level; whereinthe proximal mesh spans the aneurysm neck; and wherein the proximal meshis inside the distal mesh. In an example, an aneurysm occlusion devicecan comprise: a generally spherical mesh (or net or porous balloon)which is inserted into an aneurysm sac; wherein the generally sphericalmesh has a first elasticity level; wherein the generally spherical meshcentroid is a first distance from the aneurysm neck; and a bowl orparaboloid shaped (wire) mesh inserted into the aneurysm sac; whereinthe bowl or paraboloid shaped mesh has a second elasticity level whichis less than the first elasticity level; wherein the bowl or paraboloidshaped mesh centroid is a second distance from the aneurysm neck;wherein the second distance is less than the first distance; wherein thebowl or paraboloid shaped mesh spans the aneurysm neck; wherein aportion of the generally spherical mesh is within the concavity of thebowl or paraboloid shaped mesh; and wherein the bowl or paraboloidshaped mesh is (centrally) connected to the generally spherical mesh.

In an example, an aneurysm occlusion device can comprise: a distal (wireand/or polymer) mesh (or net or porous balloon) which is inserted intoan aneurysm sac; wherein the distal mesh is generally ellipsoidal, eggshaped, or apple shaped; wherein the distal mesh has a first elasticitylevel; and a proximal mesh inserted into the aneurysm sac; wherein theproximal mesh is bowl or paraboloid shaped with a distal-facingconcavity; wherein the proximal mesh has a second elasticity level whichis less than the first elasticity level; wherein the proximal mesh spansthe aneurysm neck; and wherein the proximal mesh is inside the distalmesh.

In an example, the convex distal mesh and the concave proximal mesh canhave different levels of flexibility. In an example, an aneurysmocclusion device can comprise: a distal mesh inserted into an aneurysmsac; wherein the distal mesh is generally ellipsoidal, egg shaped, orapple shaped; wherein the distal mesh has a first flexibility level; anda proximal mesh inserted into the aneurysm sac; wherein the proximalmesh is bowl or paraboloid shaped with a distal-facing concavity;wherein the proximal mesh has a second flexibility level which is lessthan the first flexibility level; wherein the proximal mesh spans theaneurysm neck; and wherein a portion of the distal mesh is within theconcavity of the proximal mesh. In an example, an aneurysm occlusiondevice can comprise: a distal (wire and/or polymer) mesh inserted intoan aneurysm sac; wherein the distal mesh is generally ellipsoidal, eggshaped, or apple shaped; wherein the distal mesh has a first flexibilitylevel; and a proximal mesh inserted into the aneurysm sac; wherein theproximal mesh is bowl or paraboloid shaped with a distal-facingconcavity; wherein the proximal mesh has a second flexibility levelwhich is less than the first flexibility level; wherein the proximalmesh spans the aneurysm neck; and wherein the proximal mesh is insidethe distal mesh.

In an example, an aneurysm occlusion device can comprise: agenerally-spherical distal mesh (or net or porous balloon) which isinserted into an aneurysm sac; wherein the distal mesh has a firstflexibility level; and a proximal mesh inserted into the aneurysm sac;wherein the proximal mesh is bowl or paraboloid shaped with adistal-facing concavity; wherein the proximal mesh has a secondflexibility level which is less than the first flexibility level;wherein the proximal mesh spans the aneurysm neck; and wherein a portionof the distal mesh is within the concavity of the proximal mesh. In anexample, an aneurysm occlusion device can comprise: agenerally-spherical distal (wire and/or polymer) mesh (or net or porousballoon) which is inserted into an aneurysm sac; wherein the distal meshhas a first flexibility level; and a proximal mesh inserted into theaneurysm sac; wherein the proximal mesh is bowl or paraboloid shapedwith a distal-facing concavity; wherein the proximal mesh has a secondflexibility level which is less than the first flexibility level;wherein the proximal mesh spans the aneurysm neck; and wherein theproximal mesh is inside the distal mesh.

In an example, the convex distal mesh and the concave proximal mesh canhave different levels of porosity. In an example, an aneurysm occlusiondevice can comprise: a distal mesh inserted into an aneurysm sac;wherein the distal mesh is generally ellipsoidal, egg shaped, or appleshaped; wherein the distal mesh has a first porosity level; and aproximal mesh inserted into the aneurysm sac; wherein the proximal meshis bowl or paraboloid shaped with a distal-facing concavity; wherein theproximal mesh has a second porosity level which is less than the firstporosity level; wherein the proximal mesh spans the aneurysm neck. In anexample, an aneurysm occlusion device can comprise: a distal (wireand/or polymer) mesh inserted into an aneurysm sac; wherein the distalmesh is generally ellipsoidal, egg shaped, or apple shaped; wherein thedistal mesh has a first porosity level; and a proximal mesh insertedinto the aneurysm sac; wherein the proximal mesh is bowl or paraboloidshaped with a distal-facing concavity; wherein the proximal mesh has asecond porosity level which is less than the first porosity level;wherein the proximal mesh spans the aneurysm neck; and wherein theproximal mesh is inside the distal mesh.

In an example, an aneurysm occlusion device can comprise: agenerally-spherical distal mesh (or net or porous balloon) which isinserted into an aneurysm sac; wherein the distal mesh has a firstporosity level; and a proximal mesh inserted into the aneurysm sac;wherein the proximal mesh is bowl or paraboloid shaped with adistal-facing concavity; wherein the proximal mesh has a second porositylevel which is less than the first porosity level; wherein the proximalmesh spans the aneurysm neck; and wherein the proximal mesh is insidethe distal mesh. In an example, an aneurysm occlusion device cancomprise: a generally-spherical distal (wire and/or polymer) mesh (ornet or porous balloon) which is inserted into an aneurysm sac; whereinthe distal mesh has a first porosity level; and a proximal mesh insertedinto the aneurysm sac; wherein the proximal mesh is bowl or paraboloidshaped with a distal-facing concavity; wherein the proximal mesh has asecond porosity level which is less than the first porosity level;wherein the proximal mesh spans the aneurysm neck.

In an example, the convex distal mesh and the concave proximal mesh canhave different levels of axial compliance, compressibility, and/orstiffness. In an example, an aneurysm occlusion device can comprise: agenerally-spherical distal (wire and/or polymer) mesh (or net or porousballoon) which is inserted into an aneurysm sac; wherein the distal meshhas a first level of axial compliance, compressibility, and/orstiffness; wherein the distal mesh centroid is a first distance from theaneurysm neck; and a bowl shaped proximal mesh inserted into theaneurysm sac; wherein the proximal mesh has a second level of axialcompliance, compressibility, and/or stiffness; wherein the proximal meshcentroid is a second distance from the aneurysm neck; wherein the seconddistance is less than the first distance; wherein the proximal meshspans the aneurysm neck; and wherein a portion of the distal mesh iswithin the concavity of the proximal mesh; and wherein the proximal meshis connected to the distal mesh.

In an example, the convex distal mesh and the concave proximal mesh canbe axially aligned. In an example, an aneurysm occlusion device cancomprise: a generally spherical, ball shaped, bulbous, circular, and/orglobular distal (wire and/or polymer) mesh (or net or porous balloon)which is inserted into an aneurysm sac; wherein the distal mesh centroidis a first distance from the aneurysm neck; and a bowl shaped proximalmesh inserted into the aneurysm sac; wherein the proximal mesh centroidis a second distance from the aneurysm neck; wherein the second distanceis less than the first distance; wherein the proximal mesh spans theaneurysm neck; and wherein the proximal mesh is axially-aligned with thedistal mesh. In an example, an aneurysm occlusion device can comprise: adistal polymer mesh inserted into an aneurysm sac; wherein the distalpolymer mesh is generally spherical, ball shaped, bulbous, circular,and/or globular; wherein the distal polymer mesh centroid is a firstdistance from the aneurysm neck; and a proximal polymer mesh insertedinto the aneurysm sac; wherein the proximal polymer mesh is bowl shaped;wherein the proximal polymer mesh centroid is a second distance from theaneurysm neck; wherein the second distance is less than the firstdistance; wherein the proximal polymer mesh spans the aneurysm neck;wherein a portion of the distal polymer mesh is within the concavity ofthe proximal polymer mesh; wherein the proximal polymer mesh isconnected to the distal polymer mesh; and wherein the proximal polymermesh is axially-aligned with the distal polymer mesh.

In an example, an aneurysm occlusion device can comprise: a distal metalmesh inserted into an aneurysm sac; wherein the distal metal mesh isgenerally spherical, ball shaped, bulbous, circular, and/or globular;wherein the distal metal mesh centroid is a first distance from theaneurysm neck; and a proximal metal mesh inserted into the aneurysm sac;wherein the proximal polymer metal mesh is bowl shaped; wherein theproximal metal mesh centroid is a second distance from the aneurysmneck; wherein the second distance is less than the first distance;wherein the proximal metal mesh spans the aneurysm neck; wherein aportion of the distal metal mesh is within the concavity of the proximalmetal mesh; wherein the proximal metal mesh is connected to the distalmetal mesh; and wherein the proximal metal mesh is axially-aligned withthe distal metal mesh.

I claim:
 1. An aneurysm occlusion device comprising: a peanut orhourglass shaped mesh which is configured to be inserted into ananeurysm; wherein the mesh further comprises a distal portion, whereinthe distal portion has a first thickness; and wherein the mesh furthercomprises a proximal portion which is configured to span the aneurysmneck, wherein the proximal portion has a second thickness, and whereinthe second thickness is greater than the first thickness.
 2. An aneurysmocclusion device comprising: a peanut or hourglass shaped distal meshwhich is configured to be inserted into an aneurysm sac, wherein thedistal mesh centroid is a first distance from the aneurysm neck; and abowl shaped proximal mesh which is configured to be inserted into theaneurysm sac, wherein the proximal mesh centroid is a second distancefrom the aneurysm neck, wherein the second distance is less than thefirst distance, wherein the proximal mesh spans the aneurysm neck, andwherein the proximal mesh is connected to the distal mesh.
 3. Ananeurysm occlusion device comprising: a distal mesh which is configuredto be inserted into an aneurysm sac, wherein the distal mesh is convex,and wherein the distal mesh centroid is a first distance from theaneurysm neck; and a proximal mesh which is configured to be insertedinto the aneurysm sac, wherein the proximal mesh is concave, wherein theproximal mesh centroid is a second distance from the aneurysm neck,wherein the second distance is less than the first distance, wherein theproximal mesh spans the aneurysm neck, and wherein the proximal mesh isaxially-aligned with the distal mesh.